History

A history of trauma may be apparent. In self-inflicted injury, it may not. Pain suggests trauma, ischaemia or infection. Lack of pain suggests a neuropathic cause, e.g. diabetes mellitus or tabes dorsalis. A history of varicose veins or DVT suggests a venous stasis ulcer. A prior history of intermittent claudication suggests ischaemic ulcers, as does a history of atrial fibrillation or subacute bacterial endocarditis (embolic). The presence of a longstanding venous ulcer with recent change in the shape of the ulcer suggests development of a squamous cell carcinoma (Marjolin’s ulcer).

A history of rheumatoid arthritis or collagen disease may suggest a vasculitic lesion. A pigmented ulcerating lesion arising at the site of a previous mole or de novo may suggest a malignant melanoma, especially if there is a history of prolonged exposure to the sun or sunburn. A history of any haematological conditions should be sought. Pyoderma gangrenosum may occur in association with Crohn’s disease or ulcerative colitis.