A 58-year-old man has had a discharging sinus over the tibia from chronic osteomyelitis for 25 years. Recently the sinus margins have become everted, indurated, and bleed on touch. What complication must be excluded first?

• A Amyloidosis secondary to chronic suppuration
• B Reactivation of acute osteomyelitis
• C Osteosarcoma of the tibia
• D Squamous cell carcinoma arising in the sinus tract ✓

Explanation

Long-standing sinuses of chronic osteomyelitis can undergo malignant transformation into squamous cell carcinoma, historically called Marjolin-type change when occurring in chronically inflamed or scarred tissue. Everted edges, induration, bleeding, and increasing discharge are warning signs, and biopsy of the sinus tract is mandatory. Osteosarcoma arises de novo in bone and does not present through a sinus tract.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.