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Case Study/Series
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Etiology and Pathophysiology of Cutaneous Ulcers: A series of 158 cases First Author: Seth Forman Authors: Maria Urick, NP O. Fred Miller, MD William B. Tyler, MD Tammie C. Ferringer, MD Dirk M. Elston, MD We reviewed one-hundred and fifty eight consecutive histopathological accessions with cutaneous ulcers at the Geisinger Medical Center submitted between January 1st, 2006 and June 30th, 2006. These cases were reviewed in order to better understand the underlying etiology and pathophysiology of cutaneous ulcers. Most importantly, our results revealed that fifteen (9.49%) of the cutaneous ulcers were overlying malignancies (7 melanomas, 3 basal cell carcinomas, 3 squamous cell carcinomas and 2 metastatic breast carcinomas). Six (3.79%) ulcers occurred within pre-cancerous actinic keratoses. Benign tumors were found in nineteen cases (12.02%) which included vascular tumors (7) epidermal tumors (5), melanocytic tumors (5) and dermatofibromas (2). One (0.06%) case of cutaneous t-cell lymphoma was diagnosed within an ulcer. Ulcers also were found in inflammatory conditions. Nineteen ulcers (12.02%) were a result of inflammatory conditions which included chondrodermatitis nodularis helicis (12), transient acantholytic dermatosis (2), spongiotic dermatitis (2), seborrheic dermatitis (1), lichen sclerosus and hidradenitis (1). Some ulcers were also the result of vasculopathic conditions. Seven (4.4%) were within atherosclerotic extremities which resulted in amputation. Three (1.89%) of the cutaneous ulcers were a result of livedoid vasculopathy. Forty-five of the ulcers (28.48%) were classified as benign or unspecified without suggesting an underlying or secondary etiology. Sixteen (10.12%) ulcers were found to be a result of a prurigo nodule, lichen simplex chronicus or excoriation. These three diagnoses suggest the ulcers were induced by pruritus or other cutaneous symptom. The remaining twenty-eight cases of ulcers were noted to be decubitus ulcers, neuropathic ulcers, infections, insect bites, microvascular thrombi and stasis dermatitis. The data suggests that a life threatening etiology may underlie or create a cutaneous ulcer. A biopsy can reveal the underlying etiology and pathophysiology. The appropriate therapy may be intitiated once the etiology is known. |
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