Chronic Ulceration in a Radiotherapy Site

Glenda Hall, MD, Lynne J. Goldberg, MD, Tania Phillips, MD, FRCPC

Disclosures

Wounds. 2003;15(10) 

In This Article

Presentation

A 78-year-old gentleman was referred for a non-healing ulcer in the left axilla. The patient had a history of lung cancer, which was treated with radiotherapy and chemotherapy three years earlier. About a year ago, he developed an open wound in the left axilla at the site of irradiation. He was initially treated for chronic ulceration by his cardiothoracic surgeon. His treatment regimen at the time included cleansing the wound with hydrogen peroxide and leaving it open to the air. He complained of excessive serous drainage and odor but denied pain.

The patient's past medical history was significant for prostate cancer, currently in remission, hyperlipidemia, osteoarthritis, multiple basal cell and squamous cell carcinomas of the skin, hypertension, and neuropathy of the hands and feet following chemotherapy. His medications included simvastatin, rofeoxib, folic acid, felodipine, and amitriptyline.

Cutaneous examination revealed a healthy appearing Caucasian man with extensive photodamage. In the left axilla, there was a wound measuring 2.5cm in depth and 5x3cm in surface diameter. At the margins of the wound was a raised rim of friable tissue. Initial differential diagnoses discussed included post-radiation ulceration, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC).

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