Verrucous carcinoma of the foot from chronic pressure ulcer

Abstract

STUDY DESIGN: This is a case report with literature review. OBJECTIVE: To describe a case of verrucous carcinoma, a rare histopathologic type, complicating a chronic pressure ulcer of duration less than 3 years. SETTING: The department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, USA. METHOD: A 24-year-old African-American male with long-standing incomplete paraplegia visited the wound clinic due to a pressure ulcer that had lasted for more than 1 year on the medial side of the right foot. Despite conservative management for almost 2 years after the initial visit, the ulcer is suspected to have undergone malignant transformation. Histological study led to the diagnosis of verrucous carcinoma that necessitated transtibial amputation on the right foot. RESULT: The carcinoma developed within 3 years, which was a relatively short time period for a pressure ulcer to have undergone malignant transformation. The diagnosis of verrucous carcinoma has never been reported as carcinoma complicating a pressure ulcer. No evidence of local recurrence or distant metastasis was seen in postoperative 10 months. CONCLUSION: The possibility of malignant transformation should be kept in mind in cases of pressure ulcers that are unresponsive to treatment or that show morphological changes suspected to be cancerous. Furthermore, early detection and intervention increases the probability for successful outcome.