Neoplastic change in chronic leg ulcer

Seventeen cases of chronic leg ulcers were examined, 12 males and five females, with a mean age of 45 years. The average duration of ulcers was 21 years. Eleven of the cancers arose from ulcers that recurrently healed and broke down. Three arose from ulcers that never healed and three from stable scars. Treatment was by various levels of amputation in nine patients and by excision and skin grafting in one. Histological findings showed 16 cases to be squamous cell carcinoma while one case was sarcomatous in appearance. Most of the cases were poorly differentiated and findings of pseudoepitheliomatous hyperplasia were significant. This was thought to represent earlier stages of fetoplasia which in itself may continue for many years and may be a prelude to frank neoplasia. It was therefore suggested by the authors that the laboratory study of fetal antigens or other fetal markers in these types of lesions may be useful. It was also suggested that careful examination of deeper tissues in lesions where pseudoepitheliomatous hyperplasia has been found is necessary to ascertain that there is no undetected malignancy.