The value of a biopsy in chronic ulcers: a case series

Chronic wounds affect millions of individuals in the United States. Chronic wounds of the lower extremity and foot are commonly associated with vascular insufficiency, diabetes, pressure, and neuropathy. Nonhealing wounds are at risk of severe complications, including infection, gangrene, amputation, and malignant transformation. Primary cutaneous malignancies may masquerade as nonhealing ulcers; thus, it can be challenging to differentiate between the malignant transformation of a chronic wound and a primary cutaneous malignancy with ulceration. A biopsy can be a safe, valuable tool in investigating underlying pathology in chronic wounds. Early biopsy diagnosis of malignant transformation can prevent diagnostic and treatment delays. Presented is a review of biopsy and its need and timing to identify malignant transformation in chronic wounds. The authors present 3 patient cases in which biopsies confirmed presence of malignancy in chronic ulcers.