Malignancy in Sinuses, Scars, and Chronic Ulcers, Invading Bones: A Review of 14 Cases in a Black African Population

Abstract

Background: Malignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. This study examines cases of squamous cell carcinoma developing in areas of chronic inflammation among blacks.
Aim: To evaluate the patients that presented with histopathological evidences of squamous cell carcinoma in sinuses, scars, and chronic ulcers with bone involvement

Methods: A retrospective review of 14 cases of squamous cell carcinoma of the extremities managed at Federal Medical Centre Azare and University of Maiduguri Teaching Hospital between July 2002 and June 2007 was carried out. The clinical, histopathological and radiological records were evaluated.
Results: Out of the 14 patients diagnosed with squamous cell carcinoma, there were 9 males and 5 females. The predisposing lesions were chronic osteomyelitis in 8(58%) patients, and 3(21%) each for burns scars and chronic ulcers. The average duration of lesion before the diagnosis of malignancy was 23 years. The leg was the most frequently affected part of the extremities 10 (71%), followed by the feet 3(21%) and the forearm 1(7%). The most common radiological findings were soft tissue mass,
osteolytic destruction and cortical thickening . The biopsies of all the lesions were exclusively well differentiated squamous cell
carcinoma. Treatment offered were mainly amputation in 13 (93%)
patients.

Conclusion: Chronic osteomyelitis was the most common predisposing lesions to malignant change in our centers. Well differentiated squamous cell carcinoma was the common histological pattern. Chronic ulcers and sinuses require biopsy at regular intervals for early detection of malignant change.