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Neoplastic Leg Ulcers - Diagnosis and Management

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Neoplastic leg ulcers are usually the consequence of underlying cancerous conditions. Read to know more about it.

Written by

Dr. Ruchika Raj

Medically reviewed by

Dr. Abdul Aziz Khan

Published At March 1, 2024
Reviewed AtMarch 7, 2024

What Are Neoplastic Leg Ulcers?

Neoplastic (abnormal growth) leg ulcers are common consequences of cancerous conditions and are mostly observed in individuals with underlying cancer. It affects the lower extremities mostly. These neoplastic leg ulcers can be caused by primary skin cancers such as melanoma (skin cancer caused by pigment-producing cells called melanocytes) or squamous cell carcinoma (the second most common skin cancer). Neoplastic leg ulcers can also result from metastasis or spread of cancer to other body parts. Men are more commonly affected with chronic leg ulcers than women, at a ratio of 2:1. The average age of individuals affected by chronic leg ulcers is around 45 to 75 years.

What Are the Causes of Neoplastic Leg Ulcers?

Neoplastic leg ulcers can arise from different malignancies, including primary skin cancers such as melanoma and SCC (squamous cell carcinoma). Additionally, metastatic cancer from internal organs can spread to the skin of the legs, leading to ulcer formation. The exact mechanisms underlying neoplastic leg ulcers involve the infiltration or penetration of cancerous cells into the skin tissue, disrupting normal healing processes and resulting in long-standing or chronic ulceration.

What Are the Signs and Symptoms Associated With Neoplastic Leg Ulcers?

The signs and symptoms associated with neoplastic leg ulcers involve:

  • Non-healing ulcers in the lower extremities.

  • Pain and inflammation surrounding the ulcerated area.

  • Tenderness on palpation near the ulcerated area.

  • Bleeding on touch or bleeding ulcers.

  • Discoloration in the skin surrounding ulcers.

  • Thickening or nodularity of the skin surrounding the ulcer may be present.

What Is the Clinical Presentation of Neoplastic Leg Ulcers?

The clinical presentation of neoplastic leg ulcers includes:

  • The size of the ulcer may vary from small to medium or large.

  • The borders of neoplastic ulcers are usually irregular.

  • The neoplastic leg ulcers have mostly rolled out and raised edges.

  • The color of the skin surrounding the ulcer appears to be reddish to bluish hue.

  • The ulcers may show exudate of pus or discharge from the affected area.

How Are Neoplastic Leg Ulcers Diagnosed?

The diagnostic approach for neoplastic leg ulcers includes:

  • Medical History and Clinical Examination: A detailed medical history of the affected individual, along with the complete clinical examination of the affected site, is usually performed by the specialist to rule out the causes of the leg ulcers. The clinical presentation of the ulcers should be examined carefully to rule out the diagnosis.

  • Biopsy: A soft tissue biopsy is performed by the specialist by collecting the sample of tissue from the ulcerated edges of the affected site along with the normal tissue margin and sending it to the laboratory for histopathological examination to rule the presence of cancerous cells and to determine the specific type of cancer if not self-reported by the patient or if the patient is unaware. A biopsy also helps to determine the treatment plan of the ulcerated lesion after ruling out the exact diagnosis. The FDA (Food and Drug Administration) recommends wound biopsy as the most novel diagnostic tool to identify if the ulcers are due to neoplastic changes, immune-mediated, or due to infectious disease.

  • Ultrasound and MRI (Magnetic Resonance Imaging): The ultrasound and MRI help determine the extent of the ulcers and rule out the presence of any underlying tumor.

How Are Neoplastic Leg Ulcers Managed?

The management strategies for neoplastic leg ulcers are:

Chemotherapy: It involves the utilization of different chemotherapeutic agents that inhibit the cancer cells or restrict the growth of cancer cells. Chemotherapy can be used as a monotherapy or can also be used as a combination therapy with radiation therapy and surgical intervention for the management of advanced stages of cancer.

Radiation Therapy: Radiation therapy involves the utilization of high-energy radiation to target and destroy cancer cells. It may be employed to shrink tumors, alleviate associated symptoms, or as adjuvant therapy following surgery.

Supportive Wound Care or Debridement: Proper debridement of the ulcerated wound and proper care of the affected area helps aid in the quick healing of the ulcers. Proper wound care also prevents complications associated with delayed wound healing of chronic leg ulcers and helps to promote healing. The wound debridement involves:

  1. Cleaning of the affected wound properly with the help of antimicrobial liquid.

  2. Applying proper dressing with medicament or antiseptic ointment to prevent wound infection.

  3. Resolving any underlying issues such as infection and poor blood circulation.

  4. Follow up regularly with the doctor to get the dressing changes and for the inspection of the wound to rule out signs of improvement or any infection.

Surgical Therapy: For a localized ulcer and skin cancer, surgical removal of the tumor and surrounding tissue is often recommended and performed by the surgeons. Surgical therapy for localized cancers helps to eliminate the cancer cells from the affected area and also prevents the metastasis of the cancers in the surrounding tissues.

The management of chronic leg ulcers is completely based on the underlying cause and extent of the disease. Palliative care aids in managing symptoms and better QoL (quality of life) in individuals in advanced cases.

What Is the Prognosis of Neoplastic Leg Ulcers?

The prognosis for neoplastic leg ulcers varies depending on factors such as the type and stage of cancer it is detected, the extent of ulceration, and the overall health of the affected individual. Prompt detection and management can significantly improve clinical outcomes and may prevent the progression of the disease. However, advanced cases of neoplastic leg ulcers may have a very poor prognosis, emphasizing the importance of timely intervention and ongoing medical care.

Conclusion

Neoplastic leg ulcers represent a serious complication of underlying cancerous conditions and require prompt evaluation and treatment by healthcare professionals. They result from the infiltration of cancerous cells into the skin tissue, disrupting normal healing processes and leading to chronic ulceration. Prompt diagnosis and management are crucial for better clinical outcomes and for preventing the progression of disease. By understanding the consequences of neoplastic leg ulcers, healthcare professionals can provide better patient care. Current ongoing research in management strategies offers future hopes for good clinical outcomes in the treatment of this challenging condition.

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Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology

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