Malignant Ulcer SDL

What is an ulcer?

A break in the continuity of the epithelium of the skin or mucous membrane

What are the major types of ulcers?

Venous, arterial ischemic, rheumatoid, traumatic, neuropathic, benign, and malignant ulcers

What are the key features assessed during ulcer inspection?

Size, shape, number, position, edge, floor, discharge, and surrounding area

What are the key features assessed during ulcer palpation?

Tenderness, edge, base, depth, bleeding, and relation to deeper structures

What is a benign ulcer?

A non-cancerous ulcer with regular and clean features

What is a malignant ulcer?

A cancerous ulcer caused by malignant neoplastic growth

What cancers most commonly cause malignant ulcers?

Squamous cell carcinoma and basal cell carcinoma

What age group commonly develops malignant ulcers?

Patients older than 40 years

How does a malignant ulcer typically develop?

Starts as a small nodule that enlarges, undergoes necrosis, and ulcerates

What is the typical shape of benign ulcers?

Round or oval

What is the typical shape of malignant ulcers?

Irregular

What margins are seen in benign ulcers?

Flat or overhanging margins

What margins are seen in malignant ulcers?

Heaped up, nodular, or everted margins

Describe the depth of benign vs malignant ulcers

Benign ulcers are deep and punched out while malignant ulcers are shallow and sloping

Describe the base of benign vs malignant ulcers

Benign ulcers have smooth clean bases while malignant ulcers have necrotic shaggy bases

Describe the size difference between benign and malignant ulcers

Benign ulcers are usually <2 cm while malignant ulcers are usually >3 cm

What gastric fold pattern suggests benign gastric ulcer?

Radiating rugal folds converging toward the ulcer

What gastric fold pattern suggests malignant gastric ulcer?

Loss or disruption of surrounding rugal folds

What is the hallmark feature of malignant ulcers?

Everted edge with indurated hard base and necrotic floor

What is the hallmark feature of benign ulcers?

Smooth clean punched-out appearance

What ulcer edge is characteristic of squamous cell carcinoma?

Everted edge

What ulcer edge is characteristic of basal cell carcinoma?

Rolled edge

What is a rodent ulcer?

Basal cell carcinoma with rolled edges and central ulceration

What are the features of squamous cell carcinoma ulcers?

Everted edge, hard base, induration, necrosis, and easy bleeding

What are the features of basal cell carcinoma ulcers?

Rolled edge, central ulceration, slow growth, and local invasion

What is Marjolin ulcer?

An aggressive squamous cell carcinoma arising in chronic wounds or scars

What is the most common cause of Marjolin ulcer?

Chronic burn wounds

What chronic conditions are associated with Marjolin ulcer?

Venous ulcers, pressure sores, osteomyelitis, radiotherapy scars, and chronic non-healing wounds

What are the common locations of malignant ulcers?

Lips, tongue, breast, stomach, colon, penis, and anus

What additional sites can develop malignant ulcers?

Cheek, hands, vulva, and old scars

What are the features of malignant gastric ulcers?

Irregular shape, uneven base, irregular edges, and disrupted folds

What are the features of benign gastric ulcers?

Smooth regular shape, even base, and converging folds

What does a moth-eaten appearance around gastric ulcers suggest?

Malignancy

What does clubbing or fusion of gastric folds suggest?

Malignant gastric ulcer

What does easy bleeding from an ulcer suggest?

Malignancy

What does a hard indurated ulcer base suggest?

Malignancy

What investigation confirms malignant ulcer diagnosis?

Biopsy

What is the main treatment for malignant ulcers?

Surgical excision

What are the principles of management of malignant ulcers?

Biopsy, surgery, chemotherapy, radiotherapy, wound care, infection control, pain management, and palliation

What is the role of wound care in malignant ulcers?

Control odor, discharge, infection, and improve comfort

What is the role of palliative care in malignant ulcers?

Symptom relief and quality of life improvement in advanced disease