Case Update: Chronic Ulceration in a Radiotherapy Site

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

Disclosures

Wounds. 2004;16(3) 

In This Article

Case Review

A 78-year-old man was referred for a nonhealing 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 complained of excessive serous drainage and odor but denied pain. He was cleansing the wound with hydrogen peroxide and leaving it open to the air.

According to the patient, his past medical history was significant for prostate cancer, hyperlipidemia, osteoarthritis, multiple basal cell and squamous cell carcinomas of the skin, hypertension, and neuropathy of the hands and feet following chemotherapy. His medication list included simvastatin, rofeoxib, folic acid, felodipine, and amitriptyline.

Cutaneous examination revealed a wound in the left axilla measuring 2.5cm in depth and 5x3cm in surface diameter (Figure 1). The margins of the wound were raised with a rim of friable tissue. A green discharge and foul odor were noted. Initial differential diagnoses included post-radiation ulceration, squamous cell carcinoma, and basal cell carcinoma.

This is a close-up view of the axillary basal cell carcinoma. Notice the raised rim of tissue.

Wound cultures revealed moderate Streptococcus viridans and moderate Gram-positive bacilli resembling diphtheroids. A biopsy of the raised border demonstrated atypical basaloid epithelium with peripheral nuclear palisading consistent with basal cell carcinoma.

The patient was referred back to his dermatologic surgeon and oncologist for management of the basal cell cancer. In the interim, he was treated with a course of Keflex and instructed to pack the wound with iodoform gauze daily.

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