Examples of leg ulcers of non-
causes. Ecthymas have the appearance of punched-out,
venous origin
sharply defined ulcers and tend to occur mainly on the
1) Ulcers due to very severe arte-
rial blood flow insufficiency, fre-
lower leg. Erysipelas presents as an extensive erythema
quent localization: lateral edge of
which, if left untreated, becomes necrotic and can lead to
foot and heel
ulcerative degeneration of relatively large areas of skin.
2) Ulcer due to diabetic macroan-
giopathy on the lower leg 1 3
3) Neuropathic ulcer associated
Traumatic events such as physical, chemical or thermal
with diabetes mellitus “perforat-
damage are further potential causes of leg ulcers,
ing disease”
although artefacts (self-damage) should also be included
4) Venous leg ulcer caused by
in the physician's deliberations.
chemotherapy for primary throm-
bocythemia
5) Hemorrhagic-bullous erysipelas
Neoplastic diseases such as basaliomas, spindle-cell carci-
6) Necrotising erysipelas
nomas, soft-tissue sarcomas or malignant lymphomas and
7) Leg ulcer caused by a
34 melanomas, with relevant localization, lead to neoplastic
basalioma
8) Venous leg ulcer resulting from
leg ulcer. In view of the anticipated increase in HIV-posi-
spindle cell carcinoma
tive patients, a growing incidence of Kaposi sarcomas is
to be expected. The possibility of a malignant etiology
should particularly be borne in mind when dealing with
therapy refractory “problem ulcers”. The diagnosis is
established histologically, and the importance of taking
biopsy samples at an early stage is to be emphasized.
5 6
Biopsy samples should be collected from several sites – at
the edges and in the middle of the ulcer.
78
Clinical presentation and diagnosis [22.23]
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