J Korean Foot Ankle Soc.  2023 Mar;27(1):30-34. 10.14193/jkfas.2023.27.1.30.

Six Cases of Diabetic Foot Wounds with Concomitant Skin Malignancies

• Kwon TH
• Lee T
• John Park C
• Choi YH
• Lee KM

• KMID: 2540404
• DOI: http://doi.org/10.14193/jkfas.2023.27.1.30

Abstract

Diabetic foot wounds have a significant effect on the health-related quality of life of patients. As diabetic foot wounds are usually chronic and recurrent, it is possible that they can lead to skin malignancies. Several factors can make it difficult to make an early and accurate diagnosis of skin malignancies of the foot in patients with diabetes mellitus. Even though the prevalence of diabetes mellitus and diabetic foot wounds is increasing, currently there are no guidelines for the biopsy of diabetic foot wounds. We have evolved a criterion for the above based on six cases of diabetic foot wounds with concomitant skin malignancies. We recommend that clinicians should broadly consider implementing this criterion when managing patients with diabetic foot wounds.

Keyword

Diabetic foot; Neoplasms; Biopsy; Melanoma; Squamous cell carcinoma

Figure

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  Figure. 1 Malignant melanoma arising from a darkly pigmented wound under the fifth metatarsal head.

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  Figure. 2 (A) The wound on the tip of left fifth toe bled profusely. (B) The wound appeared slightly aggravated after one month of conservative treatment. (C) Foot radiography revealed bony erosion of the distal phalanx of the left fifth toe, which coincided with the location of the wound.

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  Figure. 3 (A) Malignant melanoma of the first toe. The toe nail has been extracted spontaneously and the nail bed appears hypertrophic and well vascularized. (B) Three years earlier, the patient had developed a diabetic foot wound on the medial side of the first metatarsal head. This wound had healed spontaneously, as shown in (A).

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  Figure. 4 Malignant melanoma of the first toe. The toe nail had been extracted spontaneously before the patient visited our hospital, and the hypertrophic nail bed bled profusely.

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  Figure. 5 Acral lentiginous melanoma located between the right fourth and fifth toes. Acral melanoma is frequently misdiagnosed because it does not exhibit the classical signs of melanoma (asymmetry, irregular border, color, and large diameter).

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  Figure. 6 (A) Squamous cell carcinoma on the dorsolateral side of the midfoot. The wound appears hypertrophic and well perfused. (B) Foot radiography revealed destruction of the lateral midfoot, which suggested tumor invasion or osteomyelitis.

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