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Oral Abstracts (Session 4 of 5)
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(Presentation 35.4) Verrucous carcinoma in traumatic spinal cord injury Elsa J. Aguilera, MD, PM&R, SCIM, CWS; Aldo-Gonzalez-Serva, MD; Dominic K. Foo, MD; Shadi Fereshetian, MD; Charles D. Foster, DPM, VA Boston Healthcare, West Roxbury, Mass Background: Malignant transformation of chronic pressure ulcers (Marjolin’s ulcers) is considered a rare event in spinal cord injury (SCI). The type of transformation found in these ulcers is squamous cell carcinoma (SCC). The purpose of this study is to report verrucous carcinoma (VC) as another kind of malignant degeneration found in chronic pressure ulcers affecting traumatic SCI patients. Methods: From 1998 through 2003, 150 SCI patients underwent plastic surgery for their nonhealing pressure ulcers. Multiple biopsies of the ulcers were taken for microscopic examination for every surgical procedure. Excision biopsies were done in 2 patients, and repeated biopsies prior to surgery were done in 2 others. Results: Verrucous carcinoma was diagnosed in 5 SCI men (3 white, 2 black). The level of injury was tetraplegic in 2 (one complete, one incomplete), and paraplegic complete in 3. Age: 52 years ranging from 33 to 74. Duration of SCI: 25 years ranging from 3 to 41. Skin lesion duration: 3 years ranging from 3 months to 7 years. Discussion: The SCI literature mentions one case of VC. It was reported in a nontraumatic incomplete paraplegic. In non-SCI patients, VC is found in the oral cavity (VC of Ackerman), the anogenital region, and the plantar surface of the foot. It is described as a slow growing, recurrent, rarely metastasizing, low mortality cancer. Its pathogenesis is attributed to human papilloma viruses with weak oncogenic potential. The hybrid VC variety (SCC and VC in the same ulcer) found in one of the patients in the study is highly malignant and metastasizing. The patient died several months after diagnosis (1-year mortality rate: 100%). Conclusion: The finding of VC in 5 patients (7.5%) in this study changes the concept of Marjolin’s ulcer as a rare event (0.5%) in SCI. High awareness in diagnosing this condition is needed. References Mustoe J, Upton J, Marcellino V, Tun CJ, Rossier AB, Hachend HJ. Carcinoma in chronic pressure sores: a fulminant disease process. Plast Reconstruct Surg. 1986;77:116–121. Eltorai IM, Montroy RE, Kobayashi M, Jakowatz J, Gutierez P. Marjolin's ulcer in patients with spinal cord injury. J Spinal Cord Med. 2002;25:191–196. Wright PK, Vidyadharan R, Jose R, Rao G. Plantar verrucous carcinoma continues to be mistaken for verruca vulgaris. Plast Reconstr Surg. 2004;113:1101–1103. MY Lee, JC Shin, CI Park, DW Rha, TK Sastry. Verrucous carcinoma of the foot from chronic pressure ulcer. Spinal Cord. 2004;42:431–434 Steffen C. The man behind the eponym: Lauren J. Ackerman and verrucous carcinoma of Ackerman. Am J Dermatopathol. 2004;26:334–341 |
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