Squamous cell carcinoma foot arising in deep mycosis [chromomycosis] A case report

An 87 years old male. presented with a large foul smelling, fungating and suppurative growth over dorsum of left foot. The lesion started about 25 years ago as a small soft nodule which slowly increased in size to involve most part of the dorsal surface of the foot and transformed into a verrucuous and crusted plaque in about two decades time. The lesion remained largely asymptomatic throughout until during last one year, when it increased in size rather rapidly to involve the ankle region and lower part of the leg and he also started complaining of pain in the lesion. During last two months it became more suppurative and foul smelling. There was no history of similar lesions else where over the body and the patient did not loose any significant weight during this period. Some times in the past the lesion was diagnosed as of deep fungal infection [chromoblastomycosis] for which he received systemic antifungal [itraconazole] irregularly and the response to treatment was not satisfactory. On examination a large fungating and verrucous growth with fairly well defined margins and having hard crusts and few ulcers over the surface was seen involving dorsal aspect of the left foot, ankle region and extending up to the lower part of the leg but sparing all the toes. [Fig.l]. Inguinal lymph nodes were not appreciably enlarged on either side. Laboratory investigations including blood