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.

Squamous Cell Carcinoma Squamous Cell Carcinoma

This ulcer on the shin turned out to be a basal cell carcinoma.
Basal Cell Carcinoma on the Shin

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.
Leg Ulcer

Arteriosclerosis Obliterans

Antiphospholipid Syndrome




Klinefelter Syndrome

Cutaneous Malignancy, e.g., Squamous Cell Carcinoma or Basal Cell Carcinoma as in this case.
Basal Cell Carcinoma

Necrobiosis Lipoidica
Necrobiosis Lipoidica

Prolidase Deficiency

Pyoderma Gangrenosum. Look for a heaped-up edge. Courtesy Michael O. Murphy, MD
Pyoderma Gangrenosum

Stasis Ulcer
Stasis Ulcer

Livedoid Vasculopathy
Livedoid Vasculopathy

Drugs can cause leg ulcers, e.g., Nicorandil, Hydroxyurea.

MTHFR polymorphism can lead to arterial occlusive disease and ulcerations.

Hypertensive Ulcer of Martorell


General workup can include:


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