Squamous cell carcinoma on a leg ulcer in the West Indies

INTRODUCTION: The epidemiology of carcinoma developing on a leg ulcer is poorly, although high incidence rates are reported in Africa. PATIENTS AND METHODS: Retrospective study of cases reported in Guadeloupe, a tropical country with a large population from African descent and with high quality health care level. RESULTS: Sixteen cases, mean age 71, were diagnosed over a 10-Year period in the only referral hospital. The annual incidence was an estimated 0.4/100,000. Preceding ulcers had a long course (mean of 27 Years) and had various causes. Social distress was the rule (14/16 patients). One third of the clearly differentiated (15/16) squamous cell-type tumors exhibited metastatic extension on presentation. At Year 3, the mortality rate was of 40 p. cent. The best survival rate (6 remissions/8 cases) was associated with primary limb amputation. DISCUSSION: Malignant ulcers appeared more frequent in Guadeloupe than in the influent countries of the North, but with an instance 4-fold lower than in Africa. Like many other tropical diseases, socio-behavioral factors may play a major role.