A 50-Year-Old Man Comes to the Office Due to a Persistent

question 370

Multiple Choice

A 50-year-old man comes to the office due to a persistent ulcer on his left leg for the past 2 months.  Ten years ago, he sustained full-thickness burns to the left pretibial and ankle areas that required extensive wound care and skin autografting and resulted in significant scarring.  The patient had been doing well until 2 months ago, when he developed an ulcer associated with pain and bloody drainage within the region of the prior skin graft.  He has tried local wound care with antibiotic ointment, but the lesion has not healed.  On physical examination, there is a 3-cm, irregularly shaped ulcer on the left lower leg just proximal to the medial malleolus.  The ulcer has red granulation tissue at the base that bleeds easily when touched.  Pedal pulses are 2+ bilaterally.  The legs are symmetric in girth; there is no edema in the legs or feet.  Which of the following is the most likely diagnosis?

• A)Basal cell carcinoma
• B)Cutaneous T-cell lymphoma
• C)Delayed skin graft failure
• D)Squamous cell carcinoma
• E)Venous stasis ulcer

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Definitions:

Authorized

Having official permission or approval to do something, especially in a legal or formal context.

Contract

A legally binding agreement between two or more parties that is enforceable by law.

Surveyed

The process of examining and recording the characteristics, boundaries, and features of a land area for construction, legal, or environmental purposes.

Delaminating

The process where layers of a composite material separate or split, often due to failure in bonding.