ULCERS AND TUMOURS OF THE SKIN

The causes of these include the following:

  • Infections:
    • Bacterial: Mainly tuberculosis, leprosy, syphilis and anthrax
    • Fungal: For example, histoplasmosis.
    • Parasitic: For example, leishmaniasis
  • Tumours:
    • Squamous cell carcinoma
    • Basal cell carcinoma
    • Melanoma
    • Kaposi’s sarcoma
  • Vascular:
    • Ischaemic (arterial)
    • Venous, venous insufficiency
    • Sickle cell disease
    • Diabetes,
    • Thromboangitis
  • Trauma
  • Tropical ulcers

Clinical Features

Ulcers are mainly found in the lower limbs but may occur on any part of the body.
Examination should be thorough and systematic. The following are, with brief examples, the characteristics to note:

  • Site: For example, 95% of rodent ulcers (basal cell carcinoma) occur on the upper part of the face; carcinoma typically to the lower lip, while syphilitic chancre affects the upper lip.
  • Size: Carcinoma spreads more rapidly than inflammatory ulcer.
  • Shape: Rodent ulcers are usually circular while straight edges are found in dermatitis
  • Edge: Undermined occurs in tuberculosis, rolled edges in basal cell carcinoma, (Rodent), everted edges in squamous cell carcinoma, vertically punched out edges in syphilis and slopping edges in venous and traumatic
    ulcers.
  • Base: Is palpably indurated in squamous cell carcinoma.
  • Floor: When examined appears granulomatous in tuberculosis.
  • Discharge: Purulent discharge indicates active infection while greenish discharge is seen in pseudomonas infection.
  • Lymph nodes: Are enlarged mainly in malignant tumours.
  • Pain: Occurs generally in malignant, tuberculous, and anal ulcers, while tropical ulcers are painless.

Investigations

This depends on the causative factor and may include:

  • Haemogram
  • Pus for culture and sensitivity
  • Blood sugar
  • VDRL
  • Arteriography
  • Biopsy for histology
  • Mantoux test
  • HIV screen
  • Relevant radiographs to rule out bone involvement and/or infections.

Management

The following are important:

  • Give antibiotics for infected wounds – flucloxacillin 500mg orally 6 hourly for 7 days.
  • Conduct regular cleaning and dressing with antiseptic for 3 days.
  • Give tetanus toxoid 0.5ml IM.
  • Identify primary cause and if able to manage at this level, then manage.
  • Carry out wound excision/skin graft if no healing of the wound observed.
  • Order histology for chronic ulcers to rule out malignant conditions.
  • If necessary, treat malignant and varicose ulcers by amputation and stripping of the varicose veins, respectively.