Leg ulcers and cancer.

Objective: It is estimated that 1 leg ulcer out of 300 is a carcinoma. In t he literature ulceration of skin cancer is distinguished from chronic leg u lcers although this later category remains a subject of debate. We examined the clinical features of suspected malignant leg ulcers and discuss the no tion of secondary malignant transformation of-leg ulcers. Patients and methods: This study included patients attending the Vascular C linic at the Saint-Joseph Hospital in Paris between 1991 and 1999 who were referred for leg ulcers and whose final diagnosis was cancerous ulceration. Results: There were six patients, mean age 77 years who had squamous cell c arcinomas (4 cases) and basocellular carcinomas (2 cases). We observed two distinct situations: leg carcinomas that ulcerated from onset (2 cases) and malignant transformation of a cicatrix, known as Marjolin's ulcer (4 cases ). There were no cases of malignant transformation of chronic leg ulcers in this series. The clinical elements suggestive of a cancerous leg ulcer wer e the absence of a vascular etiology, the red, budding aspect of the ulcer with hard borders, and its development on a cicatrix. Conclusion : Malignant transformation of a vascular leg ulcer was not obser ved in our series, but has been reported In the literature although a criti cal analysis of reported data is only significant for squamous cell carcino ma. The frequency is probably overestimated. Our series enabled us to ident ify the clinical circumstances leading to an early diagnosis of carcinoma o f the lower limbs. There are three essential criteria: analysis of the vasc ular status of the patient, the clinical characteristics of the leg ulcer, and its development on a cicatrix.