By Gary M. White, MD
A leg ulcer is not a diagnosis, but instead a physical sign. The key question is, "What caused the ulcer?" Any ulcer that fails to heal within a month or so should be considered for biopsy to rule out malignancy and establish an exact diagnosis. The ulcer below, thought to be a venous stasis ulcer, turned out to be a squamous cell carcinoma.
This ulcer on the shin turned out to be a basal cell carcinoma.
This middle-aged woman had an ulcer on the left leg that took years to heal and an acute ulcer on the right leg. She had four spontaneous abortions before conceiving. Her ANA was 1:640 and she was positive for factor V Leiden mutation.
Cutaneous Malignancy, e.g., Squamous Cell Carcinoma or Basal Cell Carcinoma as in this case.
Pyoderma Gangrenosum. Look for a heaped-up edge. Courtesy Michael O. Murphy, MD
Drugs can cause leg ulcers, e.g., Nicorandil, Hydroxyurea.
MTHFR polymorphism can lead to arterial occlusive disease and ulcerations.
General workup can include: