M 58, left above-knee amputated stump with a 5.0X5.0 cm raised, exophytic, and fungating mass

    A 58-year-old man sustained a left knee dislocation with neurovascular injury in 1968.

    He underwent a left below the knee amputation and was fitted with an artificial leg. The stump was quite short, about 2-3 inches below the knee joint. He had continued difficulty with proper fitting of the prosthesis over the years. Almost 36 years later in 2004, the patient started experiencing increased pain at the amputation site and noted foul discharge from the area. The skin over the distal stump was macerated, ulcerated with purulent foul smelling exudate. He was managed in the wound care clinic with wound cleaning and antibiotics over the next year and half. During that period, the distal stump area developed enlarging hypertropic appearing fungating tissue. He was unable to use the leg prosthesis.

    The patient underwent a left above the knee amputation with an uneventful postoperative course.

    The amputated stump showed a 5.0X5.0 cm raised, exophytic, and fungating mass with central ulceration over the distal aspect of the stump (Fig. 1). Microscopically, the lesion was a verrucous type of squamous cell carcinoma showing papillomatous epidermal growth with hyperkeratosis and pushing type of dermal invasion with bulbous proliferation of well-differentiated keratinocytes (Fig. 2).

    Conference: