A prospective case–control study of non‐healing wounds of the lower limbs – the value of biopsies for ulcerating carcinoma

Background In some leg ulcer patients there is cancer that is responsible for lack of healing of such a wound. Aim This study was aimed at prospective analysis of histopathology of non‐healing wounds ( NHW s) in the patient presenting with high and low suspicion for ulcerating carcinoma. Material and methods Forty patients with NHW s were enrolled and had been prospectively divided into two groups: 25 patients with high suspicion for ulcerating carcinoma according to their medical history and physical examination, and the second group of 15 patients without suspicion for malignancy (control group). All NHW s were photographed and underwent biopsies. Results In the control group biopsies did not reveal cancers. On the contrary, in 10 patients (40%) from high suspicion group biopsies revealed cancers: seven basal cell carcinomas ( BCC s), one – malignant melanoma, one – Bowen's disease and one – squamous cell carcinomas. Histopathology of six of seven BCCs suggested that non‐healing benign wound might have preceded malignancy. We found that leg ulcers which were small (wound area less than 3 cm 2 ), longstanding (duration 24 ≤ weeks), presenting with granulation tissue covering ≥75% of the wound area, with a dull pink appearance of the granulation tissue, or an atypical clinical presentation, can actually be an ulcerating carcinoma. Dull pink granulation tissue or an atypical clinical presentation of ulceration, as a single clinical finding, suggested an underlying malignancy with a statistical significance (71.5% vs. 0%; P  = 0.001 and 27.8% vs. 0%; P  = 0.0049 respectively). Conclusions Prevalence of malignancy, primarily: BCCs in NHW s, may be higher than expected and clinical features suggestive of such a nature of ulcer are an indication for diagnostic biopsy.