EN | TR
E-ISSN: 1307-5608
The Incidence of Malignancy in the Pathology Materials of the Patients Underwent Amputation due to Diabetic Foot Ulcer and the Long-term Results of the Patients
PDF
Cite
Share
Request
Research Article
VOLUME: 72 ISSUE: 3
P: 334-338
December 2019

The Incidence of Malignancy in the Pathology Materials of the Patients Underwent Amputation due to Diabetic Foot Ulcer and the Long-term Results of the Patients

J Ankara Univ Fac Med 2019;72(3):334-338
DOI: 10.4274/atfm.galenos.2019.70894
Ömer Arda Çetinkaya
1. Ankara Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Ankara, Türkiye
No information available.
No information available
Received Date: 08.10.2019
Accepted Date: 16.12.2019
Publish Date: 23.01.2020
PDF
Cite
Share
Request

ABSTRACT

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

References

1
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-228.
2
Moxey PW, Gogalniceanu P, Hinchliffe RJ, et al. Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011;28:1144-1153.
3
Bakker K, van Houtum WH, Riley PC. The International Diabetes Federation focuses on the diabetic foot. Curr Diab Rep. 2005;5:436-440.
4
Apelqvist J, Bakker K, van Houtum WH, et al. International consensus and practical guidelines on the management and the prevention of the diabetic foot. International Working Group on the Diabetic Foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S84-92.
5
Kimbrough CW, Urist MM, McMasters KM. Melanoma and cutaneous malignant neoplasm. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery: The biological basis of modern surgical practice. 20th ed. New York: Elsevier; 2017. pp. 724-754.
6
Khan SA, Bank J, Song DH, et al. The skin and subcutaneous tissue. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s Principles of Surgery. 10th ed. New York: McGraw-Hill Education. 2015. pp. 487-493.
7
Scatena A, Zampa V, Fanelli G, et al. A metastatic squamous cell carcinoma in a diabetic foot: Case report. Int J Low Extrem Wounds. 2016;15:155-157.
8
Park HC, Kwon HI, Kim HW, et al. A digital squamous cell carcinoma mimicking a diabetic foot ulcer with early inguinal metastasis and cancer-related lymphedema. Am J Dermatopathol. 2016;38:e18-21.
9
Chiao HY, Chang SC, Wang CH, et al. Squamous cell carcinoma arising in a diabetic foot ulcer. Diabetes Res Clin Pract. 2014;104:e54-56.
10
Cavaliere R, Mercado DM, Mani M. Squamous cell carcinoma from Marjolin’s ulcer of the foot in a diabetic patient: Case study. J Foot Ankle Surg. 2018;57:838-843.
11
Mantovani A, Teobaldi I, Stoico V, et al. Cutaneous squamous carcinoma in a patient with diabetic foot: an unusual evolution of a frequent complication. Endocrinol Diabetes Metab Case Rep. 2018;2018. pii: 18-0065.
12
Dalle S, Depape L, Phan A, et al. Squamous cell carcinoma of the nail apparatus: clinicopathological study of 35 cases. Br J Dermatol. 2007;156:871-874.
13
Nasca MR, Innocenzi D, Micali G. Subungual squamous cell carcinoma of the toe: report on three cases. Dermatol Surg. 2004;30:345-348.
14
Huang KC, Hsu RW, Lee KF, et al. Late inguinal metastasis of a well-differentiated subungual squamous cell carcinoma after radical toe amputation. Dermatol Surg. 2005;31:784-786.
15
Klil-Drori AJ, Azoulay L, Pollak MN. Cancer, obesity, diabetes, and antidiabetic drugs: is the fog clearing? Nat Rev Clin Oncol. 2017;14:85-99.
16
Kawanishi S, Hiraku Y, Pinlaor S, et al. Oxidative and nitrative DNA damage in animals and patients with inflammatory diseases in relation to inflammation-related carcinogenesis. Biol Chem. 2006;387:365-372.
17
Kundu JK, Surh YJ. Inflammation: gearing the journey to cancer. Mutat Res. 2008;659:15-30.
18
Keibel A, Singh V, Sharma MC. Inflammation, microenvironment, and the immune system in cancer progression. Curr Pharm Des. 2009;15:1949-1955.
19
Kaneko T, Korekawa A, Akasaka E, et al. Amelanotic acral lentiginous melanoma mimicking diabetic ulcer: a challenge to diagnose and treat. Eur J Dermatol. 2016;26:107-108.
20
Thomas S, Meng YX, Patel VG, et al. A rare form of melanoma masquerading as a diabetic foot ulcer: a case report. Case Rep Endocrinol. 2012;2012:502806.
2024 ©️ Galenos Publishing House