CANCER OF LOWER LIMB

MELANOMA 
This is a pigmented skin cancerous lesion rarely found in our population.
SYMPTOMS 
Pain, itching, increase in size, irregular margins
Diagnosis and investigations:
Tissue biopsy, MRI or CT scan for extent of lesion and locoregional spread
Metastatic workup like chest xray, ultrasound abdomen, Liver function test.
Discussion in tumor board meeting regarding chemo or radiotherapy
TREATMENT
Usually done under general anesthesia and patient need to be admitted depends on size of the lesion
and its spread
Surgical excision with wide local margins depending on the thickness of the cancer with lymph node
clearance if sentinel lymphnode positive or atypical cells in palpable lymph node Fine needle aspiration.
Reconstruction is done with skin graft or flap.
Follow up as out patient at different intervals for surveillance of cancer recurrence.
Survival rate depends on the stage of the disease and its spread
MARJOLIJN’S ULCER
Any long standing non healing wound or unstable scar secondary to trauma, burns, may develop this
kind of cancer which is a type of squamous cell cancer of skin.
SYMPTOMS 
Ulcerated wound, pain, bleeding, discharge, restricted movements, and difficulty in walking.
Diagnosis and investigations:
Tissue biopsy, MRI of the affected site and for lymph node spread,
Metastatic workup involves chest xray, ultrasound abdomen/CT chest and abdomen, LFT, Bone scan
TREAMENT 
Discussion in multidisciplinary tumor board meeting for chemotherapy or radiotherapy
Procedure is done under general anesthesia and patient is admitted for at least 1-3 days
PROCEDURE
Surgical excision with wide local margins along with lymph node clearance if present.
Specimen is sent for final histopathology
Defect is reconstructed with flap coverage either local or free flap.
POST OPERATIVE MANAGEMTN 
Patient is discharged after a couple of days of flap monitoring then followed up as out patient at
different time intervals for flap care and surveillance of recurrence.
Overall success rate is very good in expert hands but survival depends on stage of the disease and its
spread.

Written by : Dr. Ali Adnan
Copyrights: Pakistan association of Plastic Surgeons