Clinical study and surgical treatment of neoplastic ulcers

Objective: Our aim was to study the incidence, clinical type, diagnostic aids, types of treatment and the result of treatment of leg ulcers. Materials & Methods: The study comprises 250 cases of ulcer admitted at Government General Hospital, Kakinada, E.G.Dt., AP. Taking patient history, physical and local examination were doneBlood and urine samples were collected for blood sugar lipid profile etc.Special investigation like x-ray venography arteriography, Doppler ultrasound, were done. Result: Study of sex incidence shows that preponderances of males over females . The treatment is only directed to controlling of infection & repeated dressing and they are usually of long duration. Conclusion: Lower and medial part of the leg is effected in 60% of cases. Mostly men are affected. Non specific ulcers were cured by local dressing and systemic antibiotics. Introduction Primary tumour of the skin e.g: Squamous cell Carcinoma, Basal cell carcinoma and Malignant Melanoma may present as an ulcer. In these ulcers to start with, there is a slight thickening or a small nodule which breaks down to form an ulcer. These ulcers refuse to heal and are covered with crust. The margins are irregular with rolled out and averted edges. Base of the ulcer is indurated and may be fixed to the deeper structure. Floor is covered with grayish white slough. Malignant melanoma commonly secondary to a benign pigmented tumor. Ulceration, a tendency to bleed or induration with a surrounding pigmentation should give rise to the greatest suspicions. In case of any doubt the mole must be excised widely and subjected frozen section. The primary growth may remain quite small and yet give rise to large secondary deposits. Secondary deposits are typically black, but sometime contain very little pigment or even non et al. now it is generally agreed that melanoma should be regarded as carcinomata an epithelial melanocarcinoma of the skin. The first sign of an ulcer – area of thick callus. The floor of the ulcer may not be visable but the blood is a sure indication that the skin beneathhas broken. As the callus is trimmed away, evidence of cavitation or necrosis is seen and finally the extent of ulcer can be demonstated. Indian Journal of Basic and Applied Medical Research; December 2014: Vol.-4, Issue1, P. 256-261 257 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858 The pathophysiology of these ulcer are – Atherosclerosis , calcification of arteries Microangiopathy, neuropathy & infection and impaired would healing. In diabeties mellitus the ulcer may be precipitiated atherosclerosis and minor trauma with super added infection. Usually toes and the feet are commonly affected. The ulcer usually follows after a minor trauma and slowly spreads to the surrounding area. The edges are clear cut, base is not indurated and floor is covered with slough with slight tenderness, on examination of peripherial pulses, the volume is diminished. If prompt treatment is given early the ulcer heals without any complications. Ulceration of the lower leg is Comon which may be due to injury and having a circulation strained by the wright posture of human being. There are many associations with chronic edema, induration, eczema of leg etc. inadequate vascular dynamics can be demonstration in ulcerated extremities. Ulcerations of the lower extremity is fairly common and can present as diagnostic and therapeutic problem to the surgeon. The lower leg is the seat of an ulcer many times more often than the whole of the rest of the surface of the body.It is not surprising that the legs, exposed as they are to injury and having a circulation strained by the upright posture of human beings should be the site of ulcers of many types.The surgeon often consulted by a patient with a chronic ulceration of the leg because the patient needs either skin graft or possible vascular surgery. The surgeon must aware of many conditions that produce leg ulcers and in certain types skin grafting may not be treatment of choice.The common leg ulcer is associated with chronic edema, induration, pigmentation, loss of hair, eczema of leg is also often present. Varicose veins may or may not be found. Certainly inadequate vascular dynamics can be demonstrated in many ulcerated extremities, particularly when a large segment of the venous system has been obliterated by thrombophlebitis and many ulcers are seen without evidence of obstructive thrombosis. The evidence presented and the views expressed are based on the subject and the analysis of twelve patients studied personally in unselected persons in the sense that every patient coming to us with these ulcers, has been included. Although many patients with other kinds of leg ulcers have been seen, especially whose associated with perforating ulcers, they are not included in the series, nor those rare ulcers associated with