Malignant Tumours Presenting as Chronic Leg or Foot Ulcers

Abstract

Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.

Diagnostik und Therapie des Ulcus cruris venosum: S2k‐Leitlinie der Deutschen Gesellschaft für Phlebologie und Lymphologie (DGPL) e.V.

“…Die Prävalenz von Neoplasien im UC wird in der Literatur mit 2%–10% beschrieben. Auch wenn es sich somit um eine seltene Differenzialdiagnose handelt, erfordern eine atypische Lokalisation der Ulzeration sowie divergierende sonographische Befunde immer eine weiterführende Diagnostik 30 …”

Epithelioid sarcoma with retained INI1 expression as a cause of a chronic leg ulcer

“…The interval between the manifestation of malignant ulceration and the date of initial diagnosis for all tumor types was found to be 44 months, with a range of 4 to 240 months. 9 right calf, proving occlusion of the right superficial femoral artery (Figure 2).…”

“…6,7 The three most common types of ulcerating skin tumors are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. 8,9 In addition to ES, there are case reports of other rarer skin cancer types imitating chronic leg ulcers, like cutaneous lymphoma, 10 Kaposi’s sarcoma, 11 and eccrine porocarcinoma. 12 Due to the lack of consistent clinical practice guidelines on diagnostics of non-healing ulcers, initial misdiagnoses of malignant tumors could lead to a delay in appropriate management, which can contribute to worsened patients prognosis.…”

When a heel wound is not just a wound: an unusual presentation of malignant melanoma

“…Vascular insufficiency (i.e., arterial, venous) is one of the more common causes of lower extremity ulceration, but other etiologies include infection, trauma/pressure, and cutaneous malignancy. 2,3 In the context of this patient's medical comorbidities and the relatively low incidence of melanoma in African Americans, the lesion in this case could have easily been mistaken for a noncancerous ulcer rather than melanoma.…”

“…1 Although it can often be easily identified by the "ABCDE" rule, melanoma can rarely present with unusual characteristics that mimic other skin conditions such as arterial or venous ulcers. 2 We describe the case of a 62-year-old African American man who presented to an outpatient wound care clinic for evaluation of a fungating wound on the right, medial heel after being referred by a lymphedema facility. He had a medical history significant for congestive heart failure, hypertension, and chronic lymphedema.…”