Ulcers

Venous ulcers

• Found around the lower third of the leg
• Long-standing venous ulcer may be malignant change to form a squamous cell carcinoma - Marjolin's ulcer

Basal cell carcinoma

• Basal cell carcinoma (also known as a rodent ulcer) is a locally invasive carcinoma that is more common areas of sun-exposed skin
• The carcinoma starts as a slow-growing nodule that may be itchy or sometimes bleeds
• There is necrosis of the centre, leaving a rolled edge
• Basal cell carcinoma does not metastasise and surrounding lymph nodes should not enlarge

Squamous cell carcinoma

• Bleeding is more common in squamous cell carcinoma than in basal cell carcinoma
• Enlarged lymph nodes may be present because it does metastasise
• Squamous cell carcinoma has a classic everted edge

Ischaemic ulcers

• Excruciatingly painful
• Changes to overlying dressing can be painful for several hours
• Ischaemic ulcers are characteristically deeper than venous ulcers and can penetrate down to the bone
• Surrounding area is cold as a result of ischaemia

Neuropathic ulcer

• Occur as a result of impaired sensation caused by neurological deficit of whatever cause
• Diabetes mellitus is the most common cause of neuropathic ulcers
• Characteristically painless