Saturday, January 13, 2018

Non-healing ulcer after surfing injury

Surfer's Sore

The patient is a 70 year-old surfer living in Hawaii.  Two months ago, he sustained a cut over his shin bone on a lava rock/sandstone shelf of a reef on Kauai.  It has not healed in spite of cleaning area daily with chlorhexidine scrub and applying Medihoney and triple anti bacteria ointment.  He says, "What is weird and kinda creepy is it feels like something is crawling around in there from time to time, especially while sleeping?"  The patient, a light-complected Caucasian, has a history of non-melanoma skin cancer.  He is scrupulous about sun-protection, but has spent more than a half a century with significant sun-exposure.

This is the sandstone slab on which the injury took place:
What are your thoughts?

1.  Sea Ulcers Andrew Nathanson, MD,  Surfing Medicine (Journal of Surfing Medical Association) Dec, 2014


  1. Wow. This could be anything from an infection (especially atypical mycobacteria), foreign body, or doubtfully neoplastic (traumatically-induced KA). I would recommend a shave biopsy split for cultures. I might even place him on minocycline, cultures pending. Keep us informed with the results and outcome!

  2. from Dr. Shay Bintliff, Kamuela, HI: "This is a tough one, but I would recommend removal and analysis as it could be a neoplasm.'

  3. from Dr. Robert Shapiro, Hili, HI: "I’d do a punch or deep shave to see if its a foreign body granuloma. Possibly when you lop the top off you’ll see a little rock inside."

  4. from Kris Savitsky, FNP, North Adams, MA: Really tough, with 2 months of fastidious care, I would've expected more improvement. It doesn't really have many hallmarks of infection or neoplasm. Maybe a foreign body that is prohibiting closure? Have you done a biopsy and diagnosed it yet?

  5. Bhushan KumarJanuary 15, 2018

    The rolled out edges suggest a BCC or another malignancy. However, a typical mycobacteriosis has to be ruled out. The suggestion of starting minocycline is good as we are awaiting the biopsy and culture report.

  6. Why not cover it with duoderm this, that can be ordered on amazon, until the biopsy report comes back.Change it every 4-5 days when it get soupy, wet. Although I assume it will be hard to keep her out of the water.


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