Chronic Wound? Or Ulcerated Malignancy?

Why so many CHRONIC wounds?

The incidence of chronic wounds is dramatically increasing in the US.  It’s due to a variety of different factors, including longevity as well as the increased incidence of various co-morbid conditions which predispose individuals to chronic wounds.  This includes chronic diseases such as diabetes and peripheral vascular disease.  In addition obesity is also on the rise.  The net result?  An increased incidence of individuals with non-healing or poorly healing chronic leg wounds.

Is EVERY wound a CHRONIC wound?

There is a saying that you learn in medical school…If you hear hoofbeats, don’t think of zebras.zebra-1170177_1920-pixabay

The idea is that common things are the most common causes.  In most cases that’s true, but what if something that we think isn’t common really is?  And what is common?  An incidence of 10% ? 25% ? 50% ?

Did you know that the medical literature estimates that up to 10% of chronic wounds….are really primary cancers?

I would consider this a “common” issue that needs to be considered in every wound case seen in your office ….or wound care facility.  Especially those wounds that just seem to be a little different than what you expect.  In those cases….the wound is trying to tell you something.  Listen to it.  There ARE zebras everywhere.


How do you detect the Chronic Wound Zebras?

The first element of detecting the unusual cause of a chronic wound is to have a high index of suspicion.  Perhaps great questions to ask when examining each and every chronic are:

  • “What is the cause of this wound?”
  • “How sure am I that this is the cause?”
  • “If I am wrong…what could be the consequences?”
  • “How can I evaluate this wound to either confirm I am right…or detect the correct diagnosis?”

If you go through these questions…I suspect that you will find that you are detecting a greater level of chronic wounds that are not just “simple” chronic wounds.  You will start to detect the zebras that are out there…just waiting to fool you into the wrong diagnosis.

Perhaps the best way of detecting these lesions is to use a simple punch biopsy tool.  Getting tissue under the microscope of a pathologist can provide you with an evaluation that can help identify that zebra…or confirm your clinical judgement.

Malignancy in Chronic Wounds

There are two major types of malignancy in chronic wounds.  Primary and Secondary.

Primary malignancies in “wounds” really isn’t a chronic wound…it’s an ulcerated malignancy.  The most common types of cutaneous malignancy are:

  • Squamous Cell Carcinoma
  • Basal Cell Carcinoma
  • Malignant Melanoma
  • Cutaneous metastases or direct extension of underlying tumors (such as breast cancer)
  • Other primary tumors, such as skin adnexal tumors (rare)

Secondary malignancies in wounds typically arise in long standing wounds and are a result of the chronic wound, not a cause of it.  Secondary Malignancies are sometimes called Marjolin’s Ulcers after a physician who described these lesions.  The most common type of secondary malignancy in a chronic wound is Squamous Cell Carcinoma.


In future postings…we can dive into more detail into various elements of this very important topic.

4path provides comprehensive wound biopsy evaluation, which includes detailed findings in the wound (not just a one line diagnosis…like most labs), as well as a comprehensive evaluation for the presence of primary and secondary malignancies.

Contact 4path today to provide this unique service to your patients with chronic wounds. Call 877-884-7284 (877-88-4path) or send us an e-mail to to talk with a laboratory representative about this comprehensive program.


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By |2016-12-15T17:24:38+00:00May 12th, 2016|Chronic Wound|Comments Off on Chronic Wound? Or Ulcerated Malignancy?