My 75 year-old grandmother has been suffering from varicose veins on her lower legs for several years. She initially had itchy scaly plaques around her ankles, which later developed into deeper non-healing ulcerated lesions. Recently a doctor suggested that the leg ulcer could be turning cancerous. Can this happen?

Yes, the suspicion raised by the doctor can, unfortunately, be true. Leg varicose veins are a common problem, with a higher incidence in Caucasians in general and among Britons in particular.

A genetic predisposition is believed to be an influencing factor. With growing age these varicosities tend to get progressively worse. Over a period of time the sluggish blood flow results in stasis of blood, and gradually an eczematous reaction begins on certain areas of affected skin, called stasis dermatitis.

Repeated and vigorous scratching of these itchy eczema areas can result in broken/eroded skin lesions. If left untreated, these eroded lesions can turn into ulcers, called stasis ulcers. They are extremely difficult to be effectively treated.

In many developed countries there are dedicated Leg Ulcer Units in some dermatology centres, where specially trained medical and nursing staff provide skilled professional care.

Regarding the suspected diagnosis of skin cancer developing on one margin of the long-standing, non-healing leg ulcer, the most common type is squamous cell carcinoma of skin. An urgent full-thickness skin biopsy should be taken to confirm the diagnosis. If the histopathology report establishes this, a complete extended surgical excision will be mandatory.

Because of the location involved I’m afraid it will be an uphill task for the treating surgeon to close the wound in a conventional way. Therefore, it’s quite likely that the surgeon will be compelled to close and repair the wound with a full-thickness skin graft.

A successful acceptance of grafted skin can pose another challenge to the success of the surgery. This makes it necessary for you to choose a highly skilled surgeon.