In wound care, we often focus on the Big Three: Vascular, Diabetic, and Pressure. But sometimes, the biggest threat is the one we aren’t looking for.
Not every non-healing ulcer is a circulation issue. If you are treating a stubborn wound that refuses to respond to optimal care, it’s time to look closer.
Red Flags for Malignancy (Marjolin’s, SCC, BCC):
The 3-Month Rule: No significant healing after 12 weeks of gold-standard therapy.
The Rolled Edge: Everted, thickened, or heaped up wound margins.
Hyper-Granulation: Excessive tissue that bleeds at the slightest touch (friable).
The Background: Wounds occurring in old burn scars, radiation sites, or areas of chronic inflammation.
Atypical Odor: A foul smell that persists despite appropriate antimicrobial dressings.
The Gold Standard Rule: When in doubt, take it out (or at least a piece of it). A punch biopsy is a low-cost, high-value intervention that can be the difference between a routine closure and a life-saving oncology referral.
Indicative Refs
Fang, L., Simman, R., Workman, L., Ayoub, S., & Bratton, C. (2024). Malignant wound aetiology, diagnosis and management: a case series and literature review. Journal of wound care, 33(2), 102–117.
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