Value of wound biopsy in chronic venous ulceration

Abstract

Objectives: Malignant transformation in chronic venous ulcers (CVU) is a limb threatening complication, which has an insidious onset. Clinical experience in our practice suggests a lack of suspicious macroscopic features making diagnosis difficult. The aim of this study is to evaluate the role of routine wound biopsy in the outpatient clinic for CVU without suspicious appearances but with no signs of healing despite appropriate treatment.

Methods: A three-year (2000-2003) retrospective review of records for all patients who underwent biopsy of a CVU in the outpatient clinic in a specialist wound healing clinic set in a university hospital.

Results: In our series (n =76), three indications for biopsy were identified: CVU that had developed features suspicious of carcinoma (n =17), CVU that had no suspicious features but were non-healing (n =24) and CVU that had developed features of inflammatory ulceration (n =35). A positive finding of carcinoma (squamous or basal cell carcinoma) or intraepidermal carcinoma (Bowen's disease) was made in four (24%), nine (37.5%) and 0 cases respectively.

Conclusions: Malignancy may arise in CVU without showing suspicious features and wound biopsy should be advocated for any ulcer that fails to respond to appropriate treatment.