Verrucous Carcinoma Arising In A Chronic Non-Healing Ulcer Of The Foot Of A Diabetic Patient

摘要

We report a case of a verrucous carcinoma arising in a chronic non-healing ulcer of the plantar skin in a diabetic patient. A brief review of the verrucous carcinoma of foot is presented. Source of support None Introduction Verrucous carcinoma is an uncommon, well-differentiated variant of squamous cell carcinoma that is regarded as a low grade locally invasive malignant tumor with rare potential for distant metastasis. These tumors show a clinical and pathologic similarity to condylomata acuminata, but they are usually larger, indolent and locally destructive. Verrucous carcinoma is usually seen in oral cavity, genitoanal region, and plantar surface of foot. They are known to arise in chronic ulcers, in skin after radiation therapy, old scars, and rarely in the amputation stump [1]. Case Report A 63-year-old man with a 20-year history of diabetes mellitus, peripheral vascular disease and hypertension presented with a non-healing ulcer of left foot. Approximately 18 months prior, the patient developed dry gangrene of his toes of the same foot. He underwent amputation of the 2 nd , 3 rd , and 4 th toes during that period. In addition to the gangrenous toes, a hyperkeratotic, focally ulcerated lesion over the anterior plantar surface was also identified. This was thought to be a callus. He underwent multiple debridement of the plantar lesion followed by regular wound care over this period. The lesion recurred and grew much larger with central ulceration. Subsequently, a distal amputation of the foot was performed. On gross examination, the left distal foot measured 9.0x8.0x4.0 cm. There were only two toes (small and great) attached with the left foot. There was one somewhat ill-defined, markedly hyperkeratotic and centrally ulcerated lesion measuring 3.0 x 1.7 on the plantar surface of the left foot (Figure 1). The lesion was separated from the well-healed sites of the previous toe amputation by normal skin.