A man in his forties with rapid exacerbation of chronic foot ulcers

The development of skin cancer, especially squamous cell carcinoma, is a well-known but rare and often under-recognised complication of chronic wounds and longstanding scar tissue. These skin cancers, known as Marjolin's ulcer, are more aggressive in nature than similar cutaneous cancers of different etiology, with a higher rate of local recurrence and an increased metastatic potential.

Our patient suffered severe trauma to his left leg and foot in a car accident during childhood and underwent extensive reconstruction. In the years leading up to today the left foot has been lymphedematous, with recurring sinuses and ulcerations. He was now admitted due to a rapidly progressing and debilitating wound. During the first consultation the clinical findings led to suspicion of malignancy and osteomyelitis. The histopathologic examination from our biopsies could not rule out the presence of a highly differentiated squamous cell carcinoma. MRI and bone biopsy revealed osteomyelitis.

With few exceptions, the treatment of malignancy in chronic wounds and longstanding scar tissue is surgical. Early diagnostics, including biopsies, and intervention are instrumental to a favourable outcome. We present this case report alongside current literature in order to raise awareness on the topic.