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Erfurt-Berge C, Bültemann A, Gerber V, Motzkus M, Rembe JD, Dissemond J. [Importance of biopsy in the diagnostic assessment of chronic wounds-position paper of the Initiative Chronische Wunden (ICW) e. V.]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:163-169. [PMID: 38038746 PMCID: PMC10824797 DOI: 10.1007/s00105-023-05259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic assessment of chronic wounds is essential for the initiation of causal therapeutic treatment. For diagnostic classification of the wound genesis, it may be necessary to take a tissue sample for histological and/or microbiological processing. If there is clinical suspicion of a specific cause of the wound such as a neoplasm, an inflammatory dermatosis or a pathogen-induced wound, a tissue sample for further diagnosis is required immediately. If the ulceration does not respond sufficiently to adequate causal therapy, a tissue sample for further evaluation is recommended after 12 weeks. The choice of the correct sampling technique, further storage, transport and processing are just as decisive for a reliable result as the specific question for the diagnostic laboratory.
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Affiliation(s)
- C Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - A Bültemann
- Klinik für Gefäß- und Viszeralchirurgie, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - V Gerber
- Initiative Chronische Wunden (ICW) e. V., Quedlinburg, Deutschland
| | - M Motzkus
- ZentralesWundmanagement, Evangelisches Krankenhaus Mülheim, Mülheim/Ruhr, Deutschland
| | - J-D Rembe
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Deutschland
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Maňáková T, Hojný J, Sedlář M, Vočka M, Chrz K, Mitáš P, Beneš J, Holaj R. Epithelioid sarcoma with retained INI1 expression as a cause of a chronic leg ulcer. SAGE Open Med Case Rep 2022; 10:2050313X221106259. [PMID: 35783671 PMCID: PMC9248042 DOI: 10.1177/2050313x221106259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Epithelioid sarcoma is a rare soft-tissue sarcoma typically presenting itself as
a subcutaneous or deep dermal mass in distal portions of the extremities of
adolescents and young adults. They are frequently mistaken for ulcers,
abscesses, or infected warts resistant to standard medical treatment. Patients
often develop multiple local recurrences with subsequent metastases. We report a
case of a 66-year-old patient with chronic leg ulcer who died of generalization
of an epithelioid sarcoma.
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Affiliation(s)
- Tatjana Maňáková
- Institute of Pathology, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Hojný
- Institute of Pathology, General University Hospital in Prague, Prague, Czech Republic
| | - Martin Sedlář
- 1st Department of Surgery, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michal Vočka
- Department of Oncology, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Kristian Chrz
- 1st Department of Surgery, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Petr Mitáš
- 2nd Department of Cardiovascular Surgery, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jiří Beneš
- Department of Radiodiagnostics, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Robert Holaj
- 3rd Department of Medicine, General University Hospital in Prague, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Malignant Tumours Presenting as Chronic Leg or Foot Ulcers. J Clin Med 2021; 10:jcm10112251. [PMID: 34067425 PMCID: PMC8196993 DOI: 10.3390/jcm10112251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.
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Cheng B, Jiang Y, Fu X, Hao D, Liu H, Liu Y, Huang Z, Tan Q, Wang L, Hu D, Yang Y, Han C, Cheng Z, Ran X, Li Y. Epidemiological characteristics and clinical analyses of chronic cutaneous wounds of inpatients in China: Prevention and control. Wound Repair Regen 2020; 28:623-630. [PMID: 32585756 DOI: 10.1111/wrr.12825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/04/2020] [Accepted: 04/23/2020] [Indexed: 02/05/2023]
Abstract
The increased incidence of chronic cutaneous wounds is likely to lead to increased mortality, and therefore, deserves greater attention. More insight is needed into the magnitude of the problem of chronic cutaneous wounds and methods for their prevention and treatment in China. A retrospective analysis of data retrieved from an electronic health-records database on 3300 patients with chronic skin wounds was conducted from 1 January 2018 to 31 December 2018. The patients had been admitted to the medical and surgical wards of 17 third-grade class-A hospitals in China. The study's aim was to compare the characteristics (eg, demographic and clinical) associated with different causes and distributions of patients' chronic wounds. Among the 3300 patients, 66.03% were males and 33.97% were females. The mean age was 57 years and the increasing prevalence of chronic skin wounds with aging was quite high. The primary causes of chronic wounds were diabetes or infection, followed by pressure ulcers, trauma, and iatrogenic wounds. The distribution of skin wounds was mainly in the lower extremities (56.1%), followed by the trunk (18.6%). The mean duration of hospital stay was 29 days and the mean recurrence was 3 months. Chronic skin wounds were related to occupation, educational level, lifestyle habits, and income. The main cause of chronic skin wounds has shifted from trauma to chronic disease. Normalization checks, bacterial cultures, and antibiotic use in China need to be standardized and the training of wound specialists should be further strengthened. The association of aging and wound infection was significant. Preventive management and efficient treatment should correspond to the needs of the different regions of China. These results may serve as a reference for other developing countries in their transitional development.
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Affiliation(s)
- Biao Cheng
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou, China
| | - Yufeng Jiang
- Wound Healing Center, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Xiaobing Fu
- Wound Healing Unit, Medical Innovation Department and the Fourth Medical Center, PLA General Hospital and PLA Medical College, Beijing, China
| | - Daifeng Hao
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongwei Liu
- Department of Plastic Surgery, the First Affiliated Hospital, Jinan University, Guangzhou, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies Plastic Surgery of Jinan University, Guangzhou, China
| | - Yi Liu
- Center of Burns and Plastic Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Zhifeng Huang
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qian Tan
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Lingfeng Wang
- Department of Burns Surgery, Inner Mongolia Baogang Hospital, Inner Mongolia burn Medical Research Institute, Baotou, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, The First Affiliated Hospital (Xijing Hospital), Air Force Military Medical University, Xi'an, China
| | - Yanqing Yang
- Department of Plastic surgery, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China
| | - Chunmao Han
- Department of Burns, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Zhifeng Cheng
- Department of Endocrinology and Metabolism, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xingwu Ran
- Diabetic Foot Care Centre, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Department of Burn and Plastic Surgery, The Affiliated Hospital of Jining Medical University, Jining, China
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Kirchberger MC, Erfurt-Berge C. [Management of malignant wounds]. Z Gerontol Geriatr 2019; 53:572-576. [PMID: 31578610 DOI: 10.1007/s00391-019-01629-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022]
Abstract
Malignant wounds arise either primary or secondary in the context of a malignant transformation of already existing wounds. A plethora of skin tumors, such as basal cell carcinoma, squamous cell carcinoma, melanoma, lymphoma as well as cutaneous metastases of other malignancies can ulcerate and be the cause of malignant wounds. Ulcerating tumors or metastases of the skin can however mimic chronic wounds from other causes and remain unrecognized over a longer period. In patients with chronic ulcerations, the correct and timely diagnosis is paramount. Based on this, the stage and disease-oriented treatment should be chosen in harmony with the wishes of the patient. In addition, general measures, such as atraumatic dressing changes to reduce pain and bleeding and the use of antiseptic dressing materials to prevent bacterial colonization and associated odors should be considered.
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Affiliation(s)
- Michael Constantin Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Cornelia Erfurt-Berge
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
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