Case Report

Squamous cell carcinoma developed on neglected, mistreated and delayed diagnosed chronic venous leg ulcer

Laura Maria Curic* and Marino Cordellini

Published: 04 February, 2019 | Volume 3 - Issue 1 | Pages: 016-021

Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.

Read Full Article HTML DOI: 10.29328/journal.ascr.1001026 Cite this Article Read Full Article PDF


Chronic venous leg ulcer; Malignant transformation; Squamous cell carcinoma



  1. Pekarek B, Buck S, Osher L. A comprehensive review on Marjolin’s ulcers: diagnosis and treatment. J Am Col Certif Wound Spec, 2011; 3: 60–64. Ref.: https://goo.gl/jJuNTR
  2. Celić D, Lipozenčić J, Ljubojević Hadžavdić S, Kanižaj Rajković J, Lončarić D, et al. A Giant Basal Cell Carcinoma Misdiagnosed and Mistreated as a Chronic Venous Ulcer. Acta Dermatovenerol Croat. 2016; 24: 296-298. Ref.: https://goo.gl/K9CVX9
  3. Lestre S, Serrão V, João A, Lobo L, Apetato M. Giant basal cell carcinoma presenting as a chronic leg ulcer. Eur J Dermatol. 2010; 20: 227-228. Ref.: https://goo.gl/he79YU
  4. Combemale P, Bousquet M, Kanitakis J, Bernard P. Angiodermatology Group, French Society of Dermatology. Malignant transformation of leg ulcers: a retrospective study of 85 cases. J Eur Acad Dermatol Venereol. 2007; 21: 935-941. Ref.: https://goo.gl/XBeJd9
  5. Granel F, Barbaud A, Schmutz JL. Basal and squamous cell carcinoma associated with chronic venous leg ulcer. Int J Dermatol. 2001; 40: 539-540. Ref.: https://goo.gl/LW9DUa
  6. Gosain A, Sanger JR, Yousif NJ, Matloub HS. Basal cell carcinoma of the lower leg occurring in association with chronic venous stasis. Ann Plast Surg. 1991; 26: 279-283. Ref.: https://goo.gl/ZWenRN
  7. Cassarino DS, Derienzo DP, Barr RJ. Cutaneous squamous cell carcinoma: a comprehensive clinicopathologic classification – part two. J Cutan Pathol. 2006; 33: 261–279. Ref.: https://goo.gl/nS7U3D
  8. Robson MC, Cooper DM, Aslam R, Gould LJ, Harding KG, et al. Guidelines for the treatment of venous ulcers. Wound Repair Regen. 2006; 14: 649–662. Ref.: https://goo.gl/o5L5m6
  9. Lu H, Ouyang W, Huang C. Inflammation, a key event in cancer development. Mol Cancer Res. 2006; 4: 221–233. Ref.: https://goo.gl/Ef739V
  10. Itzkowitz SH, Yio X. Inflammation and cancer. IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol Gastrointest Liver Physiol. 2004; 287: G7–G17. Ref.: https://goo.gl/m1jacX
  11. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002; 420: 860–867. Ref.: https://goo.gl/EGMHWW
  12. Fulton AM, Loveless SE, Heppner GH. Mutagenic activity of tumor-associated macrophages in Salmonella typhimurium strains TA98 and TA100. Cancer Res. 1984; 44: 4308– 4311. Ref.: https://goo.gl/FaHCcP
  13. Maeda H, Akaike H. Nitric oxide and oxygen radicals in infection, inflammation, and cancer. Biochemistry (Mosc). 1998; 63: 854–865. Ref.: https://goo.gl/cyveJA
  14. Sirbi AG, Florea M, Patrascu V, Rotaru M, Mogos DG, et al. Squamos cell carcinoma developed on chronic venous leg ulcer. Rom J Morphol Embryol. 2015; 56: 309-313 Ref.: https://goo.gl/EEH3kN
  15. Senet P, Combemale P, Debure C, Baudot N, Machet L, et al. Malignancy and chronic leg ulcers: the value of systematic wound biopsies: a prospective, multicenter, cross-sectional study. Arch Dermatol. 2012;148: 704-708 Ref.: https://goo.gl/NA2m1i
  16. Jankovic A, Binic I, Ljubenovic M. Basal cell carcinoma is not granulation tissue in the venous leg ulcer. Int J Low Extrem Wounds. 2008; 7: 182-184. Ref.: https://goo.gl/FZdL7r
  17. Harris B, Eaglstein WH, Falanga V. Basal cell carcinoma arising in venous ulcers and mimicking granulation tissue. J Dermatol Surg Oncol. 1993;19: 150-152. Ref.: https://goo.gl/atDNt9
  18. D’Avila F, Diogo F, D’Avila B, Arnaut M Jr. Use of local muscle flaps to cover leg bone exposures. Rev Col Bras Cir. 2014; 41. Ref.: https://goo.gl/KE68px
  19. Filippini A, Zuccarini F, Di Paolantonio G, Valbonesi L, Guerra L, et al. The distal pedicle fasciocutaneous flaps of the leg. Analysis of 21 cases of lower limb reconstruction. Ann Ital Chir. 1995; 66: 479-484. Ref.: https://goo.gl/X1w8JoVendramin FS. Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações. Ver Bras Cir Plást. 2012; 27: 309-315.
  20. Hughes LA, Mahoney JL. Anatomic basis of local muscle flaps in the distal third of the leg. Plast Reconstr Surg. 1993; 92: 1144-1154. Ref.: https://goo.gl/tsu8uW
  21. Gir P, Cheng A, Oni G, Mojallal A, Saint-Cyr M. Pedicled perforator (propeller) flaps in lower extremity defects: a systematic review. J Reconstr Microsurg. 2012; 28: 595-601. Ref.: https://goo.gl/rhbBAZ
  22. Nelson JA, Fischer JP, Brazio PS, Kovach SJ, Rosson GD, et al. A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high? Microsurgery. 2013; 33: 5785-86. Ref.: https://goo.gl/NfSYBJ
  23. Buchner M, Zeifang F, Bernd L. Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients. Ann Plast Surg. 2003; 51: 266-272. Ref.: https://goo.gl/ECFLxB
  24. Sundell B, Asko-Seljavaara S. Transposition of muscle flaps for covering exposed bone in the leg. Ann Chir Gynaecol. 1979; 68: 1-5. Ref.: https://goo.gl/KnmTEP
  25. Magee WP Jr, Gilbert DA, McInnis WD. Extended muscle and musculocutaneous flaps. Clin Plast Surg. 1980; 7: 57–70. Ref.: https://goo.gl/iKb4Bf
  26. Hallock GG. Getting the most from the soleus muscle. Ann Plast Surg. 1996; 36: 139–146. Ref.: https://goo.gl/ipyqAY
  27. Heller L, Levin LS. Lower extremity microvascular reconstruction. Plast Reconstr Surg. 2002; 108: 1029-1041. Ref.: https://goo.gl/7tzqzt
  28. Pu LLQ, Medalie DA, Rosenblum WL, Lawrence SJ, Vasconez HC. Free tissue transfer to a difficult wound of the lower-extremity. Ann Plast Surg. 2004; 53: 222-228. Ref.: https://goo.gl/mwRk4K
  29. Pu LLQ. Successful soft-tissue coverage of a tibial wound in the distal third of the leg with a medial hemisoleus muscle flap. Plast Reconstr Surg. 2005; 115: 245–251. Ref.: https://goo.gl/Td87YY
  30. Pu LL. The reversed medial hemisoleus muscle flap and its role in reconstruction of an open tibial wound in the distal third of the leg. Ann Plast Surg. 2006; 56: 59–64. Ref.: https://goo.gl/4GUJZz
  31. Pu LL. Further experience with the medial hemisoleus muscle flap for soft-tissue coverage of a tibial wound in the distal third of the leg. Plast Reconstr Surg. 2008; 121: 2024-2028. Ref.: https://goo.gl/pqDW4f
  32. Arnold PG, Yugueros P, Hanssen AD. Muscle flaps in osteomyelitis of the lower extremity: a 20-year account. Plast Reconstr Surg. 1999; 104: 107-110. Ref.: https://goo.gl/VFZMuS
  33. El-Khatib HA. The split peroneus muscle flap: a new flap for lower leg defects. J Plast Reconstr Aesthet Surg. 2007; 60: 898-903. Ref.: https://goo.gl/6ZNLPj
  34. Rios-Luna A, Fahandezh-Saddi H, Villanueva-Martínez M, López AG. Pearls and tips in coverage of the tibia after a high energy trauma. Indian J Orthop. 2008; 42: 387-394. Ref.: https://goo.gl/qha1vW
  35. Ahmad I, Akhtar S, Rashidi E, Khurram MF. Hemisoleus muscle flap in the reconstruction of exposed bonés in the lower limb J Wound Care. 2013; 22: 635: 638-40, 642. Ref.: https://goo.gl/iT7Zbb


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