The management of malignant lower limb ulcers: clinical considerations

Lower limb malignant ulcers are an uncommon finding, making diagnosis complex and their management costly. Yet, despite this, the increase in skin cancers over the past 30 years means that clinicians require an awareness and understanding of their existence, particularly in the primary care setting. Familiarity with common aetiologies and presentations is vital for prompt recognition, diagnosis and referral of wounds suspicious for malignancy. Lower limb malignant wounds often develop insidiously, with a wide variation in clinical presentation that overlaps between entities. Therefore, a fundamental algorithm for approaching lower limb ulcers that raise suspicion of malignancy should be possessed by all clinicians. This article reviews the clinical features of malignant wounds that should alert clinicians to the need for further evaluation, such as atypical location and appearance. The authors also highlight the various diagnostic and therapeutic modalities available and review current clinical guidelines for the referral and follow-up of suspicious lesions.