Malignancy in Chronic Leg Wounds: Diagnostic Delay and Clinical Implications in a Tertiary Wound-Care Cohort

Abstract

Chronic leg wounds are common in wound-care practice and are most often attributed to vascular or inflammatory etiologies. Rarely, they may represent or conceal underlying malignancy, and delayed recognition can lead to inappropriate management and poor outcomes. We aimed to evaluate diagnostic delay, clinical warning signs, histopathological findings, management strategies, and outcomes in patients with malignancy-associated chronic leg wounds treated in a tertiary wound-care setting. We conducted a retrospective observational study of consecutive patients with chronic lower-leg wounds (> 6 weeks' duration) diagnosed with underlying malignancy between 2015 and 2022. Clinical characteristics, time to biopsy, histopathological findings, treatment, and outcomes were analysed descriptively. Among 328 patients with chronic leg wounds, eight (2.4%) were diagnosed with malignant etiologies. Mean ulcer duration at biopsy was 11.3 months (range 6–24), exceeding guideline-recommended timelines. All wounds failed to heal despite standard care. Common red-flag features included disproportionate pain, necrosis or bleeding, and atypical appearance. Earlier biopsy and multidisciplinary management were associated with improved wound outcomes, whereas prolonged diagnostic delay correlated with advanced disease and poor prognosis. Malignancy should be considered in any chronic leg wound failing to improve within 4–12 weeks or showing atypical features, and early biopsy is essential to optimise outcomes.