Atypical presentation of melanoma and non-melanoma skin cancer as chronic non healing ulcers
T. Sgontzou, E. Agiasofitou, F. Liordou, I. Hatzimichail, E. Zouridaki
Wound Healing Unit (WHU), “A. Sygros” Hospital, Athens, Greece
The objective of the study is to present three cases of patients, who referred to the wound healing unit of “A. Sygros” hospital for unusual, clinically heterogenouschronic ulcers that turned out to be atypical presentation of melanoma and non-melanoma skin cancer.
Patient 1 was an 81-year-old diabetic man with a 4-month history of static nonhealing ulcer on the right heel. Clinically the ulcer was mimicking a stage II pressure ulcer although the patient's history didn't support it. Because during debridement removable tissue was friable and was bleeding, a biopsy was performed.
Patient 2 was a 70-year-old man with a 12-year history of nonhealing ulcer on scarred skin of the left knee that was caused by a thermal burn at the age of five. Two biopsies were taken from the wound edge during one year follow up in order to rule out Marjolin’s transformation, without any pathological evidence. The third biopsy was taken from a reddish nodule that newly came out from the ulcer.
Patient 3 was a 78-year-old man with a 10-year history of four nonhealing ulcers on the lower extremities and four biopsies were performed from each single wound.
Patients' 1 and 2 biopsies revealed amelanotic malignant melanoma (AMM).
Patient 3's biopsies revealed four BCC’s, two of which resembled SCC’s diversion.
AMMs are rarely seen as chronic nonhealing ulcers. Their metastatic dynamic is life threatening, so early diagnosis is vital in their management. Moreover, in such a case like four Marjolin’s ulcers presented in one person, timely diagnosis is of utmost importance, so that complete local excision can be achieved, sparing the patient from more radical treatment such as amputation and preventingmetastasis.