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. 2021 May 22;10(11):2251.
doi: 10.3390/jcm10112251.

Malignant Tumours Presenting as Chronic Leg or Foot Ulcers

Frédéric Toussaint  1 , Michael Erdmann  1   2 , Carola Berking  1   2 , Cornelia Erfurt-Berge  1
Affiliations

Malignant Tumours Presenting as Chronic Leg or Foot Ulcers

Frédéric Toussaint et al. J Clin Med. .

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.

Keywords: basal cell carcinoma; chronic ulcer; melanoma; squamous cell carcinoma; venous leg ulcers.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study population. ICD-10-GM code (German version of the 10th version of the International Classification of Diseases) C43.7—melanoma of the lower limb. ICD-10-GM code C44.7—other malignant neoplasms of the skin of the lower limb. * one patient with two basal cell carcinomas presenting as chronic ulcers.
Figure 2
Figure 2
Locations of the malignant tumours presenting as chronic ulcers. For example, four misdiagnosed melanomas were situated on the hallux. SCC—squamous cell carcinoma; BCC—basal cell carcinoma; MM—melanoma.
Figure 3
Figure 3
Example of a MM on the heel, initially misdiagnosed and treated as traumatic wound.
Figure 4
Figure 4
Example of an SCC on the toe, presenting as a chronic ulcer of an unknown etiology.
Figure 5
Figure 5
Example of a BCC on the lateral gaiter area, misdiagnosed as a chronic venous ulcer.
See this image and copyright information in PMC

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