Here - EWMA 2013

POSTER PRESENTATIONS
P 404
ECCRINE POROCARCINOMA MIMICKING A VENOUS LEG ULCER
Poster: Case Study
Juergen Bauerschmitz 1 , Cornelia Erfurt-Berge 1
1 University Hospital Erlangen/Department of Dermatology (Erlangen, Germany).
Aim: Differential diagnoses of leg ulcers different to vascular origin are sometimes very
late taken into account, including malignant processes. This can be applied especially
for cases when clinical findings mimic a putatively clear diagnosis.
Methods: An 82-year-old man was referred to our department for evaluation of a
chronic leg ulcer which first appeared two years ago on the right lateral lower leg as an
initially scaling plaque. During the two years before admission the patient was treated
regularly by his general practitioner. Physical examination revealed an ulcer of the lateral
right leg, which was 3 x 4 cm in size and had a circumjacent erythematous margin.
Histological analysis of several specimen from the lesion including immunohistochemical
staining was concordant with the diagnosis of an eccrine porocarcinoma.
Results: A total excision of the ulcerated tumour with a clinical safety margin of 10 mm
and down to the fascia was performed in local anaesthesia and the resulting defect of 5
cm in diameter was provided with a mesh graft skin transplant from the right upper leg
14 days after sufficient granulation tissue had appeared. Organic or lymph node
metastasis could be excluded.
Conclusions: Obtaining histologic confirmation about the correct diagnosis is gained by
performing multiple biopsies on several points of a suspicious ulcer. As a conclusion, a
high level of suspicion in early detection of malignant tumours mimicking vascular leg
wounds is important whenever ulcers fail to respond to conventional therapies.
POSTER: CASE STUDY
P 405
Poster: Case Study
THE USE OF DACC-COATED ANTIMICROBIAL DRESSINGS FOR THE TREATMENT
OF OVER-GRANULATION
Sarah Rushton 1 , Nicola Ambrose 2 , Judith Diamond 2 , Tina Butler 2 , Darren Harris 2 ,
Laura Everitt 2 , Amy Gorman 2
1 BSN Medical Ltd (United Kingdom);
2 Medway Community Healthcare (Rochester, United Kingdom).
Aim: To determine the effectiveness of DACC-coated antimicrobial dressings1 in the
management of over-granulation.
Method: DACC-coated dressings were applied and covered with an appropriate
secondary dressing. Dressing change intervals ranged from alternative to 3- 4 days.
Results: All patients’ over-granulation was resolved when previous treatments had
failed. Two examples are presented below: Patient 1: Following a nail avulsion in June
2012 and four weeks of treatment with a foam, the wound began to over-granulate.
DACC-coated dressings were applied, changing every 3 days. By the end of July, the
wound had healed.
Patient 2: During March 2012, a 78 year old male was referred following a fall in January
2012. The wound was over-granulating and, as it had been present for 8+ weeks, it was
assumed this was due to high levels of bioburden. DACC-coated dressings were applied
and changed every 3 – 4 days. After 10 days, the over- granulation had reduced and the
dressings no longer required. The wound completely healed by April 2012
Conclusion: Over-granulation prevents the migration of epithelial tissue across the
wound bed. The cause is unknown but is suggested it may be due to high wound
bioburden. As such, first-line treatment at the clinic is an antimicrobial dressing. DACCcoated
dressings were tried as an alternative to silver dressings due to their antimicrobial
properties but also as they can be safely use for prolonged periods. Excellent results
were seen in resolving over-granulation and assisting complete healing.
1 Cutimed Sorbact
232