The Point Prevalence of Malignancy in a Wound Clinic

The aim of this study was to determine the prevalence of malignant leg ulcers and to identify the most frequent characteristics of such wounds. This study was a retrospective investigation of patients with chronic leg ulcers in a North American tertiary wound clinic. Between January 2011 and September 2013, a total of 1189 patients with lower extremity wounds, including 726 patients with leg wounds, were identified. A total of 124 of the 726 had undergone a biopsy of their atypical wound, 16.1% (20/124) of which were malignant. Patients with malignant wounds were older than patients with nonmalignant leg wounds (P < .0001), and the common location of the malignant wound was the anterior shin (odds ratio = 3.5). The limitation of this analysis is the lack of distinction between malignant transformation of wounds and de novo presentation of malignancies as chronic nonhealing wounds. Three distinguishing morphological features in malignant wounds were irregular borders (P = .0002), presence of hypergranulation tissue (P < .0001), and friable/bleeding wound surface (P < .0001). The frequency of malignant wounds in patients with chronic leg ulcers highlights the need for a systematic approach, which would involve biopsy of wounds to identify malignancy in this patient population early on.