Squamous cell carcinoma of the foot arising in chronic ulcers in leprosy patients

Abstract

Summary Squamous cell carcinoma (SeC) of the foot is a rare sequelae of chronic ulceration secondary to leprosy neuropathy. Most of the tumours are relatively slow growing and tend to metastasize late. Survival after local excision is generally good. In this series of 17 patients so far there have been 3 deaths attributable to see, all of whom presented with locally advanced tumours and lymph node metastasis.Leprosy is a chronic infectious disease caused by My cobacterium leprae which pre dominantly affects skin and peripheral nerves. Damage to peripheral nerves occurs as a result of host immunity (reversal reaction, i.e. delayed-type hypersensitivity) to the presence of bacteria in nerves or as a result of fibrosis due to chronic inflammation in peripheral nerves.This results in sensory, motor and autonomic loss in the affected limbs. As a result of paralysis of the dorsiflexors (damage to the common peroneal nerve) of the fo ot the forefoot is subjected to more pressure than usual with each step. Damage to the posterior tibial nerve results in anaesthesia of the plantar surface and some loss of cushioning in the fo ot due to wasting of the fo ot intrinsic muscles. Patients with insensitive fe et are prone to recurrent wounds which often become secondarily infected. Secondary infec tion can lead to the absorption of digits. A proportion of patients with chronic ulcers (usually those present for more than 10 years 3 -5 ) develop see ' which is usually of low grade malignancy.

Squamous Cell Carcinoma in Chronic Ulcer in Lepromatous Leprosy

“…Chronic ulcers, usually on the feet, 9 are the most common complication in patients with leprosy presenting with chronic peripheral neuropathy (neuropathic ulcers) 6,8,9 . Neoplastic transformation of ulcers was thought to be rare, 8 but recent epidemiologic studies have shown that malignant transformation of chronic ulcers in patients with leprosy is more common than previously believed 9,10 . The first report of malignant transformation of chronic ulcers in patients with leprosy was described in 1942 10 .…”

Squamous cell carcinoma in chronic trophic ulcers of leprosy patients

“…Recent epidemiological studies proved this complication was not as rare as it has been considered in the past. 1,2 We present two leprosy patients who developed squamous cell carcinoma (SCC) in chronic trophic ulcers. This is the first report from Greece.…”

“… 3–7 A variety of predisposing factors are mentioned, such as long duration of the ulcer, constant irritation and traumatization, chronic infection with or without osteomyelitis, poor hygiene, environmental factors, genetic factors, repeated cytodestructive treatments such as cryotherapy and curettage. 1,2,4 Men 60–69 years of age suffering for 30–35 years of BT or BL are most likely to develop malignancy. Nerve damage is quite severe in BT or BL; which explains why patients with this type of leprosy are at high risk.…”

“… 3 Death due to metastatic spread occurs in 5–17% of cases. 1,2 Well‐differentiated SCC is the most common (74%) tumour, followed by verrucous epithelioma. Multiple biopsies must be taken from different sites of the suspicious lesion to confirm the diagnosis.…”

“…Radical amputation either of the forefoot or below the knee is the treatment of choice in most cases. 1,2,7 Actinotherapy is indicated for recurrences or in cases of verrucous epithelioma. Chemotherapy is used only in metastatic disease.…”