Objectives:

Diabetic patients have a risk of developing diabetic ulcers up to 25% during their lifetime. Some of these diabetic foot ulcers result in amputation during the follow-up period. The amputated limb materials are not always referred for pathological evaluation. However, malignancy can be seen in these materials. In this study, pathology materials of patients who were amputated for diabetic foot ulcers were evaluated.

Materials and Methods:

Six hundred and eighty patients who underwent amputation and 688 amputation materials between January 2007 and July 2019 for diabetic foot ulcers were included in the study. From 171 out of 680 patients, 174 amputation materials were sent for pathological examination due to clinical suspicion. The demographic and clinical characteristics of these patients were analysed retrospectively through the hospital information management platform.

Results:

Malignancy was detected in four (2.3%) of 171 patients. Two of these patients were female and two were male. The mean age was 64.2±10.7 years. The age of chronic ulcers was 122, 245, 187, and 158 months in these patients, respectively. Ulcer was localized on the toe of three patients; one was localized in the heel region. Three patients had squamous cell carcinoma and one patient had malignant melanoma. No patient was in metastatic stage at the time of diagnosis. Patients are still alive and have been followed in medical oncology for a mean of 72±38 months without local recurrence and distant metastasis.

Conclusion:

Although the development of malignant lesions on the basis of diabetic wound is rare, squamous cell carcinoma, and more rarely, malignant melanoma and basal cell carcinoma may develop. Therefore, amputation materials should be sent to pathological evaluation in all patients who underwent amputation due to diabetic ulcer; even in the presence of excessive granulation or atypical appearance in diabetic ulcers without amputation, a biopsy of the ulcer should be performed and followed up for malignancy.

Keywords: Amputation, Diabetic Foot Ulcer, Malignant Melanoma, Marjolin’s Ulcer, Squamous Cell Carcinoma