title: Squamous cell carcinomas in chronic venous leg ulcers. Data of the German Marjolin Registry and review.
abstract: BACKGROUND
  Secondary squamous cell carcinoma (SCC) is a rare complication of chronic venous leg ulcers. So far, little is known about its pathophysiology and clinical behavior. Initiated by the working group "Wound Healing" (AGW) of the German Society of Dermatology (DDG), it is the objective of the current Marjolin registry to collect cases of SCC arising in venous ulcers, in order to evaluate diagnostic characteristics.
  
  
  METHODS
  All members of the AGW received questionnaires inquiring about basic patient data, ulcer characteristics, and therapy conducted.
  
  
  RESULTS
  From 2010 to 2013, 30 patients (20 women, 10 men) from six tertiary wound care centers were registered. Mean age was 76.17 years. The average duration of venous leg ulcers prior to SCC diagnosis was 15.93 years. Suspicious wound characteristics primarily included: pain (n = 3), therapy resistance (n = 27), and fetor (n = 12) as well as clinical appearance (n = 10) with atypical morphology, nodular wound bed, and hypergranulation.
  
  
  CONCLUSIONS
  Atypical morphology or changes in appearance as well as therapy resistance despite optimal care (6-12 weeks) should prompt physicians to take spindle-shaped, if necessary multiple and serial, biopsies. Primary risk factors for malignant transformation include patient age and ulcer duration.
authors.affiliation: Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany.|Artemed - Vein competence centre, Dermatology & Vascular Surgery, Bad Oeynhausen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Reich-Schupke
authors.affiliation: Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Doerler
authors.affiliation: Department of Dermatology and Allergology, Academic Teaching -Hospital Dresden-Friedrichstadt, -Dresden, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Wollina
authors.affiliation: Clinic for Dermatology, -Venereology and Allergology, -University Essen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Dissemond
authors.affiliation: Clinic for Dermatology, Venereology and Allergology, Krefeld, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Horn
authors.affiliation: Clinic for Dermatology, Venereology and Allergology, University Tübingen, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Strölin
authors.affiliation: Clinic for Dermatology, Venereology and Allergology, University Erlangen, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Erfurt-Berge
authors.affiliation: Department of Dermatology, Venereology and Allergology, Vein centre - Dermatology & Vascular Surgery, Ruhr-University Bochum, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Stücker
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality*; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007871:Leg Ulcer / Q000401:mortality*; D008297:Male; D011230:Precancerous Conditions / Q000401:mortality*; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality*; D015996:Survival Rate