An 81-year-old man presented with a wound on his right lower extremity that occurred three years ago. It was initially the size of a quarter and slowly enlarged. He also reported burning pain in the affected leg but did not have fever or chills. He did not recall any trauma or injury to the area. The patient had a history of chronic venous insufficiency, essential hypertension, and aortic stenosis.

On physical examination, the wound measured 13 cm × 8.5 cm and was located just above the medial malleolus with proximal extension (Figure 1). Surrounding erythema was present with 1+ pitting edema to the upper one-third of the anterior shin. There was no loss of hair on the distal leg. The dorsalis pedis and posterior tibial pulses were intact in the right foot.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

• A. Arterial insufficiency ulcer.

• B. Cellulitis.

• C. Contact dermatitis.

• D. Stasis dermatitis with ulceration.

Discussion