In the last post on Chronic Wounds…I had described that the two major classes of malignancy in wounds were primary and secondary.
Primary malignancies are malignancies first, with ulceration secondary. Secondary malignancies, also known as Marjolin’s ulcers are tumors which develop because of the chronic wound.
In this post let’s look at the three most common types of PRIMARY cutaneous malignancies that develop and can ulcerate to give the impression of a chronic wound.
Squamous Cell, Basal Cell, Melanoma, Oh My!
For most physicians who don’t treat or diagnose cutaneous malignancies on a regular basis, it’s sometimes hard to remember the behavior of the various malignancies. A couple of years ago I did a lecture for a large group of non-pathologist residents on this topic. To help them remember the behavior of the different malignancies, I compared these three different tumors to the “bad guys” from the Wizard of Oz.
Yes, I know it sounds weird, but it seems to have worked. Periodically I run into one of those residents and they tell me that it was a fun and easy way to remember the behavior. So…I though I would share it with you.
Basal Cell Carcinoma
This is a common malignancy of the skin and arises from the BASAL CELL region of the epidermal layer. Basal Cell Carcinoma (BCC) is the most common skin cancer with close to 3 million cases in the US annually. Despite the volume of these tumors, death from this lesion is very rare. BCC is commonly associated with sun exposure in light complexion individuals. These lesions behave like the Winkie Guards of Oz. They are aggressive locally, and can cause significant local destruction, especially if left untreated, but BCC rarely metastasizes (i.e. it can’t “fly”). Want to learn more? Click here.
Squamous Cell Carcinoma
This too is a common malignancy of the skin but arises from the UPPER region of the epidermal layer. There are approximately 700,000 cases diagnosed each year with around 5,000 deaths each year. It’s commonly associated with sun exposure and early lesions (“in-situ”) are extremely common, especially in light complexion individuals. These lesions behave like the Flying Monkeys of Oz. They are aggressive locally (like SCC, they can cause significant local destruction), but in addition, they have a higher potential for distant metastasis (i.e. can “fly” like the monkeys). Here is a link where you can learn more about this tumor.
So by now you can see the pattern between the Villains of Oz and the common cutaneous tumors. And with this knowledge, you can probably guess who represents Malignant Melanoma (MM): Yes it’s the Wicked Witch of the West. The similarities are obvious. Both are very evil. Both can be highly destructive locally. And both are very adept at flying (metastasizing). Although the least frequent of the common cutaneous tumors with under 100,000 cases annually, they probably produce the highest number of deaths. These tumors arise from the cells in the skin that produce pigment, the melanocytes. It’s important to remember that melanoma, just like the other skin cancers, can be cured if caught and excised early enough, but is highly lethal if left untreated. To learn more about malignant melanoma, click here.
I hope that this comparison helps you remember each of these three important cutaneous malignancies and provides you with a memorable way of remembering their behavior.
Next post…let’s cover another aspect of Chronic Wounds…
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 firstname.lastname@example.org to talk with a laboratory representative about this comprehensive program.
Photo credits: These images are obtained on line but are from the original movie produced by MGM. One of the greatest movies ever.