Squamous cell carcinoma arising in osteomyelitis and chronic wounds - Treatment with Mohs micrographic surgery vs amputation

BACKGROUND. Squamous cell carcinoma (SCC) is a rare, but well-documented complication of osteomyelitis and chronic wounds. Treatment of choice for these tumors commonly occurring on the legs has been amputation. Two recent articles have suggested the utility of Mohs micrographic surgery (MMS) as a limb saving procedure. OBJECTIVE. To discuss the process of decision analysis in patients with SCC arising in osteomyelitis and chronic wounds. METHODS. Four patients with SCC (three developing in association with chronic osteomyelitis, one after a burn wound) are presented. RESULTS. Two patients underwent MMS as a limb-saving procedure, while the other two underwent amputation. Only two of our patients were able to have MMS since we were confronted with factors that precluded the use of this technique. These factors included the presence of metastatic disease and the potential for the loss of a functional limb after surgery. CONCLUSIONS. Our series confirms the utility of MMS as a potentially limb-saving procedure in patients with SCC arising in either chronic wounds or in association with osteomyelitis. Despite this, patients with distant spread of their disease or extensive local disease leading to the potential loss of functional stability of the leg postoperatively may not be candidates for MMS and may require amputation. (C) 1996 by the American Society for Dermatologic Surgery, Inc.