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Malaya Santos, Tulane University, 3008 15th Street Apt 4, Metairie, LA 70002, (504) 554-0345, msantos@tulane.edu
Neurotrophic ulcers, extremely common in Hansenšs Disease (HD), present a therapeutic challenge as they are chronic, recurrent and difficult to treat. Occasionally squamous cell carcinoma (SCC) can develop in chroniculcers. Three patients with biopsy-proven SCC in ulcers were identified from the records of the National Hansenšs Disease Program. All had lepromatous HD of at least 20 years duration, inactive at the time they developed SCC, with multiple neurologic deficits and secondary deformities. Malignant degeneration occurred in non-healing ulcers located in the foot or ankle, ranging induration from four to thirty years. Two patients underwent below-knee amputation, and the third, amputation of the affected toe. Histopathologic examination revealed SCC in all three patients. Two patients had good post-operative function with no evidence of metastasis and no recurrence to date. However, the third patient developed metastases to local and regional lymphnodes, and to the lungs, and died 7 months after being diagnosed with SCC. The mechanism of malignant degeneration is not precisely understood, but chronic irritation and infection, with resulting degeneration and regeneration have been implicated, as well as decreased vascularity and a weakened epithelium unable to withstand carcinogens. However, its occurrence reminds us of the need for follow up in treated HD. The poor outcome in our third patient also emphasizes that SCC in trophic ulcers in leprosy, despite an indolent nature, can be lethal. A high index of suspicion is needed, in order to provide early diagnosis and appropriate treatment.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.