Treatment of carcinomatous degeneration in patients with chronic
osteomyelitis requires differentiation between benign, penetrating
epithelioma and invading, low-grade squamous-cell carcinoma. Although most
lesions are low grade, analysis of the case histories of twenty-three
patients treated at the Mayo Clinic indicates that these tumors do
metastasize. When malignant-appearing epithelium invading bone is
identified, ablative surgery is indicated. Inadequate surgical treatment
resulted in the deaths of two patients in our series. Routine regional
lymphadenectomy at the time of amputation seems unnecessary. Regional
lymphadenopathy persisting for six to twelve weeks after amputation
warrants surgical intervention. With prompt, aggressive surgical treatment,
the prognosis for patients with squamous-cell carcinoma in an osteomyelitic
cavity is good.