Malignant Melanoma Misdiagnosed as a Diabetic Foot Ulcer

NewsBot · Dec 6, 2012

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Malignant Melanoma Misdiagnosed as a Diabetic Foot Ulcer
Alper Ata, MD; Ayse Polat, MD; Fatih Tanrıverdi, MD; and Ali Arıcan, MD
WOUNDS 2012;24(2):43–46

Malignant melanoma, although rare, is a skin cancer with the highest mortality. This report presents a 55-year-old man who had been followed-up for diabetes mellitus for 14 years, and was diagnosed with a malignant melanoma that had developed on the base of a diabetic foot ulcer. The major common characteristic of malignant melanomas misdiagnosed as foot ulcer in the literature was that these cases have a very aggressive course, and metastasize in a short time. Thus, early biopsy is required in painful, pigmented foot ulcers with atypical localization that do not respond to standard treatment in patients with diabetes.
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Admin2 · Feb 16, 2013

Related threads:
Other threads tagged with cancer
Melanoma of the foot
Amelanotic melanoma misdiagnosed as a diabetic foot ulcer

NewsBot · Feb 16, 2013

Red flags and alarm bells: an atypical lesion masquerading as a diabetic foot ulcer.
Koo E, Walsh A, Dickson H.
J Wound Care. 2012 Nov;21(11):550, 552.

An 88-year-old male presented at a high-risk foot service with a non-healing, plantar wound on his right foot, which had the appearance of a neuropathic ulcer. On further examination, the lesion was confirmed asymmetrical in shape and atypical in appearance. It also presented with surrounding violaceous, pigmented nodules in the arch of the foot, and several small, similar nodules on the plantar surface of the contralateral foot, giving the appearance of an exophytic lesion and suggesting melanoma. Following biopsy, it was diagnosed as classic Kaposi sarcoma.
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matthew malone · Mar 2, 2013

An extensive primary nodular melanoma of the foot with associated distant metastases: a case report.
Malone M, Gannass A, Binahmed A, Bowling FL, Boulton AJ.
Foot (Edinb). 2012 Sep;22(3):235-9. doi: 10.1016/j.foot.2012.02.011. Epub 2012 May 3.

A Nodular Melanoma of the foot is a relatively uncommon disease, which accounts for the dearth of literature. The anatomical location of a primary malignant melanoma is of prognostic importance as primary lesions of the foot and ankle have poorer prognostic outcomes. This single case reports a life-threatening presentation, of a primary nodular melanoma of the foot with associated distant metastases of the skeletal system, organs and lymph nodes.

NewsBot · May 15, 2013

Melanoma arising in chronic ulceration associated with lymphoedema.
Turk BG, Bozkurt A, Yaman B, Ozdemir F, Unal I.
J Wound Care. 2013 Feb;22(2):74-5.

Chronic ulceration can be complicated by development of a malignancy. The most frequent associated malignances are squamous cell carcinoma and basal cell carcinoma, although melanoma, leiomyosarcoma and adenocarcinoma are less commonly seen. Chronic lymphoedema may also predispose to development of some malignancies, including lymphangiosarcoma, squamous cell carcinoma and Kaposi's sarcoma. Here, we report the case of a 77-year-old man with primary lymphoedema, who developed melanoma in a chronic foot ulcer of 60 years' duration. The patient underwent wide excision for the melanoma, and remains free from metastases at 1-year follow up.
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NewsBot · Mar 20, 2014

Squamous cell carcinoma arising in a diabetic foot ulcer.
Chiao HY, Chang SC, Wang CH, Tzeng YS, Chen SG.
Diabetes Res Clin Pract. 2014 Jan 14.

Diabetic complications such as poor circulation and nerve damage can result in loss of sensation and slower wound healing in the lower extremities. The possibility of malignancy arising in association with chronic osteomyelitis in the diabetic foot should also be considered.
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NewsBot · Feb 21, 2015

An interesting case of ‘diabetic foot ulcer’ in an HIV-positive patient
Venkat Sivaprakasam; Catherine Chima-Okereke
Int J STD AIDS March 2015 vol. 26 no. 4 285-287

Kaposi sarcoma is a highly vascularised tumour affecting the skin, lymph nodes and viscera. Kaposi sarcoma is most common in HIV-infected homosexual or bisexual men. We present here a 70-year-old white British male patient, who was under the care of the podiatric team for longstanding ‘diabetic foot ulcers’. He was later referred to the Dermatology team who took a biopsy; this revealed features of Kaposi sarcoma which prompted an HIV test which was positive. This patient had previously presented to several healthcare professionals with symptoms suggestive of HIV infection. He was started on antiretroviral therapy and the HIV and human herpesvirus-8 viral loads became undetectable in the blood within weeks and he showed significant clinical improvement. This case report is a reminder to clinicians to have a high index of suspicion in patients presenting with symptoms and signs suggestive of HIV infection.
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NewsBot · Sep 26, 2015

Acral melanoma with satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry.
Mansur AT et al
Int Wound J. 2015 Sep 24. doi: 10.1111/iwj.12481

Acral lentiginous melanoma affects the palms, soles, and nail apparatus. Around 3-15% of all cutaneous melanomas are located on the foot and have a poorer prognosis than melanoma elsewhere. Possible reasons for this prognostic difference may be omitting this area during routine skin check by both the patient and the physicians, in addition to misdiagnosis of melanoma as other benign skin lesions. We describe here an elderly female patient treated for a non-healing foot ulcer interpreted as a diabetic ulcer, which after 2 years was diagnosed as acral melanoma with satellitosis. Histopathological examination of the amputated distal phalanx revealed an advanced stage melanoma with 1?2 cm Breslow thickness and of Clark level 5. Dermoscopy of the bluish papulonodules scattered on the dorsal foot showed characteristic findings described for metastasis of skin melanoma. This case underlines the importance of considering skin malignancies in case of chronic, non-healing ulcers in diabetic patients. Furthermore, we point out the critical significance of skin examination as a whole, and dermoscopy being an important tool in the diagnosis of melanoma and/or cutaneous melanoma metastasis.
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NewsBot · Feb 1, 2016

A Digital Squamous Cell Carcinoma Mimicking a Diabetic Foot Ulcer, With Early Inguinal Metastasis and Cancer-Related Lymphedema.
Park HC, Kwon HI, Kim HW, Kim JE, Ro YS, Ko JY.
Am J Dermatopathol. 2016 Feb;38(2):e18-21

Although squamous cell carcinoma (SCC) is the second most common nonmelanoma skin cancer, clinicians have difficulty diagnosing SCC of the toe because its clinical features can mimic other less serious diseases. Clinicians are especially prone to misdiagnose SCC of the toe as diabetic foot ulcer in patients with diabetes mellitus because of the clinical similarity of the 2 ailments. SCC of the toe is generally considered to have a low risk of metastasis. Locoregional or distant metastases without bone or tendon involvement are particularly rare. The authors report here an interesting case of rapidly spreading SCC of the toe with metastasis to multiple lymph nodes and cancer-related lymphedema. Physicians should be aware of the possibility of malignancy when they encounter chronic and recalcitrant ulcerative lesions of the digits.
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NewsBot · Mar 20, 2016

Rare cause of non-healing foot wound - acral lentiginous melanoma. Case Report.
Gerslova A et al
Neuro Endocrinol Lett. 2016 Feb 19;37(1):12-17

The etiology of skin integrity disorders of the lower extremities can be very diverse. In addition to common diagnoses such as venous ulcers with ischemic etiology, decubitus ulcers and diabetic foot syndrome, ulceration of a malignant etiology must also be considered. Malignant melanoma is one of the most dangerous forms of skin cancer and, although rare, may cause foot lesions. The most frequently encountered type of melanoma on acral parts of the limbs is the rare acral lentiginous variant, which only occurs in 2-10% of all melanoma types. Clinical manifestation ranges from cutaneous surface erosion to ulceration with surrounding hyperkeratosis, which can cause considerable differential diagnostic difficulties in the management of patients with non-healing foot wounds. This paper aims to present a clear case study of a Caucasian female with chronic leg ulceration that resulted in a final diagnosis of malignant acral lentiginous melanoma. Supplemental theoretical information regarding the diagnosis and treatment of malignant melanoma has also been included in the report. Malignant acral lentiginous melanoma is a rare cause of non-healing wounds, but it must be considered in cases with long-term healing complications. Precise diagnostic deliberation is crucial in the management and treatment of all chronic and long-term non-healing lesions, and appropriately performed biopsies are essential to determine whether malignancy is the primary cause.
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NewsBot · Apr 6, 2016

A Metastatic Squamous Cell Carcinoma in a Diabetic Foot
Case Report
Alessia Scatena et al
International Journal of Lower Extremity Wounds April 5, 2016

A 72-year-old male was referred to our hospital for a plantar ulceration that had occurred many years earlier. The lesion, with exuberant granulation and large areas of necrosis and fibrin, had long been treated by plastic surgeons with no positive evolution. At admission in our hospital no ischemia was detected, and foot radiograph was negative for bone involvement. The patient underwent a foot magnetic resonance imaging, which showed high vascularization in the plantar region and early capture of the contrast medium. We then performed multiple biopsies of the ulceration that revealed a moderately differentiated squamous cell carcinoma. The total body computed tomography exam raised a systemic involvement. A lymph node biopsy and immunohistochemistry assay on the pleural cytological sample proved the presence of a primary squamous cell carcinoma of the foot with systemic dissemination. Although rare, squamous cell carcinoma could be associated with chronic nonhealing ulcers; therefore, when a lesion does not heal, despite adequate standard treatment, its etiopathogenesis should be challenged.
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NewsBot · Nov 12, 2016

Can a diabetic foot be malignant?
Zaidi MS, Hassan A, Ouizi S.
J Pak Med Assoc. 2016 Nov;66(11):1487-1489.

Diabetes has been linked with malignancies like colon, rectum, liver, biliary tract, pancreas, kidney, leukaemia and melanoma. Melanoma can sometimes manifest as a diabetic foot ulcer.We describe an elderly male with Type 2 diabetes, who had presented to us with a non-healing wound at the right heel, that later turned out to be an invasive malignant melanoma.
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NewsBot · Jul 22, 2017

Malignant melanoma misdiagnosed as diabetic foot ulcer: A case report.
Gao W, Chen D, Ran X.
Medicine (Baltimore). 2017 Jul;96(29):e7541. doi: 10.1097/MD.0000000000007541.

RATIONALE:
Acral lentiginous melanoma (AML) does not exhibit the classic signs of malignant melanoma. ALM is frequently misdiagnosed because of its unusual sites and atypical clinical morphologies, which lead to poor prognosis.
PATIENT CONCERNS:
A female patient aged 78 years was presented to our center with two ulcers on her right foot. Diabetic foot ulcer was considered as the primary diagnosis. The ulcers failed to improve after 2 weeks' therapy.
DIAGNOSES:
An incisional biopsy of the lesion revealed malignant melanoma.
INTERVENTIONS:
The patient received wide excision, skin grafting as well as biotherapy.
OUTCOMES:
The lesion was healed and no other metastasis has been founded until now.
LESSONS:
Clinicians must maintain a high level of suspicion in distinguishing malignant melanoma from other more benign skin lesions of the foot. The need for early biopsy of ulcer, even when clinical suspicion is low, can not be overemphasized. Only in this way can we reduce misdiagnosis rate and improve survival rate in patients with foot ulcer.
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NewsBot · Aug 2, 2017

Squamous Cell Carcinoma Arising in a Chronic, Nonhealing Diabetic Foot Ulcer.
Larijani B, Tavangar SM, Bandarian F
Wounds. 2017 Jul;29(7):E48-E50.

Diabetic foot ulcers (DFUs) are a severe and costly complication of diabetes and may result in foot amputation.
CASE REPORT:
A 69-year-old man with a 10-year history of type 2 diabetes, who was undergoing routine care for diabetes in the authors' clinic, developed a DFU of his right foot of 4 years' duration. The wound did not respond to conventional treatments, and imaging studies were normal. His 2 biopsies tested negative for malignancy. The DFU was fully removed surgically. Following surgical removal, squamous cell carcinoma (SCC) was diagnosed in the histologic study of the wound.
CONCLUSION:
Clinicians should consider a diagnosis of SCC in any chronic, nonhealing DFU. Early surgical resection of a chronic, nonhealing DFU may prevent development of SCC in an ulcer.
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NewsBot · Jan 19, 2018

Malignant Transformation of a Site of Prior Diabetic Foot Ulceration to Verrucous Carcinoma: A Case Report.
Priesand SJ, Holmes CM
Wounds : a Compendium of Clinical Research and Practice [01 Dec 2017, 29(12):E125-E131]

The case of a 62-year-old Caucasian man with type 1 diabetes who developed malignant transformation of an area of prior diabetic foot ulceration (DFU) is reported. He had significant hallux valgus deformity, multiple episodes of healing and breakdown, and eventual transformation to verrucous carcinoma (VC). This case report highlights the malignant transformation of a site of previous DFU to VC, which, to the best of the authors' knowledge, has not yet been described in the literature. There has been little research performed that examines VC in the diabetic population. This case report also highlights the importance of clinical suspicion for malignant transformation as well as the use of subsequent biopsy when necessary.
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NewsBot · Jan 30, 2018

Mistaken Diabetic Ulcers: A Case of Bilateral Foot Verrucous Carcinoma
Vanessa Di Palma et al
Case Reports in Dermatological Medicine
Volume 2018 (2018), Article ID 4192657, 3 pages

Verrucous carcinoma (VC) is a rare, low-grade, and well-differentiated variant of squamous cell carcinoma. These tumors are slow-growing and exophytic and have a negligible incidence of metastasis. Treatment is complete surgical resection, ideally by Mohs micrographic surgery, to ensure adequate clear margins. Cutaneous VC predominantly occurs on the plantar surface of the foot and rarely occurs in multiple sites. This case study describes the fourth reported occurrence of bilateral VC of the feet in a woman with chronic diabetic foot ulcers. The case provides further support for persistent wounds contributing to the development of this lesion and describes their role in the characteristic delay in diagnosis of VC.
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NewsBot · Mar 4, 2018

Squamous Cell Carcinoma From Marjolin's Ulcer of the Foot in a Diabetic Patient: Case Study
Raymond Cavaliere et al
The Journal of Foot and Ankle Surgery; 2 March 2018

Squamous cell carcinoma (SCC) has been commonly reported by foot and ankle specialists. Marjolin's ulcer is a malignancy that involves a posttraumatic scar or ulceration that can develop into SCC from chronic neuropathic pedal wounds, venous stasis, or decubitus ulcerations. Most Marjolin's ulcers are found in the lower extremity, specifically the feet, and it is twice as common in females as males. Biopsy of the tumor is the reference standard to diagnose SCC, and wide excision of SCC is the most common treatment option. The present case study describes an 83-year-old diabetic wheelchair-bound female who presented to the wound care clinic with a right heel nonhealing pressure ulceration. After biopsy and surgical excision, the patient was found to have SCC. This case was followed up for 5 years in which the patient had successful excision of the tumor with no recurrence. The clinical significance of our case study is to assist in the diagnosis, management, and prognosis of patients with SCC. In addition, this study has shown that adequate excision of the tumor margins and depth is necessary to prevent potential recurrence and metastasis.
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NewsBot · Nov 6, 2018

A rare case of primary ulcerated amelanotic nodular malignant melanoma in the diabetic foot.
Diabetic Foot Journal . 2018, Vol. 21 Issue 4, p247-253. 7p.
Gray, Katie; Hill, Saul; Hayhurst, Sarah Jane

An 81-year-old male with type 2 diabetes mellitus was admitted to hospital following a cardiac arrest. He was the primary informal carer for his wife who suffered from dementia. His medical history was sparse, suggesting he did not access regular medical care. Upon admission, his physical assessment revealed a large ulcerated fungating mass on his left foot for which he was referred to the multidisciplinary diabetic foot team who advised urgent surgical biopsy. The patient reported self-treating the lesion with a razor blade, believing it to be a corn, and had not accessed medical or podiatric care in the community. Following a series of investigations, the patient was diagnosed with aggressive stage IV malignant melanoma due to a rare, primary ulcerated, amelanotic nodular malignant melanoma of his left foot with secondary metastases in the lungs, liver and stomach. Although his cardiac condition was stable, due to his functional decline combined with the invasive nature of his cancer, his treatment plan consisted of palliative care in a specialist unit. Over the next 18 days, he deteriorated rapidly and passed away due to his cancer. Malignant melanoma is the most lethal form of skin tumour, responsible for 79% of skin cancer deaths. The nodular subtype is an invasive and aggressive tumour, which often ulcerates. Malignant melanoma are frequently misdiagnosed as diabetic foot ulcers and, therefore, clinicians should have a high degree of suspicion when managing atypical lesions. Clinicians should consider early specialist dermatological input and biopsy of a non-healing diabetic foot ulcer in the presence of adequate offloading and patent arterial supply and the absence of infection or in those with atypical features. This case study highlights the vulnerable nature of elderly informal carers who may present late for medical treatment and shows the fatal consequences of a late-presenting malignant melanoma.
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NewsBot · Jan 13, 2019

Non-healing ‘diabetic’ ulceration which turned out to be a lentiginous melanoma: a case from a diabetic foot clinic

NewsBot · Jan 18, 2019

The Misdiagnosis of Acral Lentiginous Melanoma: Three Case Presentations.
Stowers JM et al
J Am Podiatr Med Assoc. 2019 Jan 16

Acral lentiginous melanoma (ALM) is a disease that is found on the palms, soles and nail-beds. Since these areas are not often examined during general medical examinations, the presence of ALM often goes unnoticed or the diagnosis is delayed. Research shows that the misdiagnosis of ALM is common, reported between 20-34%. We present three cases of ALM that were initially misdiagnosed and referred to the senior author in an effort to assess why misdiagnosis is common. The existing literature illuminates clinical pitfalls in diagnosing ALM. The differential diagnosis of many different podiatric skin and nail disorders should include ALM. While making the correct diagnosis is essential, the prognosis is affected by the duration of the disease and level of invasiveness. Unfortunately, most of the reported misdiagnosed cases are of later stage and worse prognosis. This review highlights that foot and ankle specialists should meet suspect lesions with a heightened index of suspicion and biopsy when acral non-healing wounds and/or lesions are non-responsive to treatment.
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NewsBot · Jan 27, 2019

Foot Metastasis from Parotid Gland Cancer Mimicking a Diabetic
Foot Wound; Report of a Case
Sevtap Karaman et al
J Cancer Sci Clin Ther 2018; 2 (4): 098-99 DOI: 10.26502/jcsct.5079013

A 52 year-old-man with known parotid gland cancer presented with metastasis of foot. The lesion mimicked diabetic
foot ulceration. In this report we aimed that; underlie the distant metastasis of parotid gland cancer and consider the
possibility of tumor metastasis in lesion resembling diabetic foot ulceration.
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NewsBot · Jul 14, 2019

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient
Garneisha M. Torrence and James S. Wrobel
Clinical Diabetes and Endocrinology20195:8

Background
The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed.

Case presentation
The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A shave biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma.

Conclusions
The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.
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NewsBot · Nov 13, 2019

Malignant Transformation in Diabetic Foot Ulcers—
Case Reports and Review of the Literature
Stefan Dohr et al
Geriatrics 2019, 4, 62;

An imbalance of regeneration and destruction of the extracellular matrix due to a plethora
of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive
painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU).
Along general lines, wound healing and cancer development are similar. Therefore chronic wounds
prepare a breeding ground for cancer development. Several characteristics such as increase in size,
verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic
wound. While previously the term Marjolin’s ulcer was attributed to a malignant tumor in (burn)
scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic
ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of
squamous cell carcinoma in patients with DFU—a 71 year-old woman and a 67 year old man. Both
received total tumor excision and split-skin grafts with good short-time results.
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NewsBot · Mar 18, 2020

The heel amelanotic melanoma, a rare subtype of skin cancer misdiagnosed as foot ulcer: A case report.
Hakamifard A et al
Int Wound J. 2020 Mar 11

Amelanotic melanoma (AM) of the heel is a very rare subtype of malignant melanoma in which the tumour cells, unlike other types of melanoma, are characterised by little or no melanin pigmentation. AM resembles many benign dermatological complications that often lead to late diagnosis of lesions, poor prognosis, and occasionally misdiagnosis at an early stage of the disease. We report a case of a 73-year-old man with a heel ulcer who was admitted to Al-Zahra Hospital (Isfahan, Iran). Chronic osteomyelitis was considered the primary diagnosis, and several courses of antibiotics were prescribed for the patient. The ulcer failed to improve after 9 months' of therapy, and because of an increase in the size of the ulcer and the growth of two tumours in the right heel, a biopsy of the lesion was conducted. The pathology report confirmed invasive AM. The present report emphasises the necessity to biopsy all skin lesions, even with low clinical significance, to avoid wrong subsequent treatments, prevent a delay in diagnosis, reduce misdiagnosis, and improve the survival rate of patients.
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NewsBot · Nov 1, 2020

Spindle Cell Melanoma Presenting as an Ulcer in a Black Diabetic
D A Gaskin et al
Case Rep Pathol. 2020 Oct 11;2020

Background. Melanoma in blacks is uncommon and exceedingly rare in association with a diabetic ulcer. We present a case of a spindle cell melanoma masquerading as a diabetic ulcer. Case Report. A 57-year-old overweight woman presented to The Maria Holder Diabetes Centre for the Caribbean with a nonhealing ulcer of the right heel after being treated by various primary care physicians over the preceding year. Her general and systematic examinations were unremarkable. There was a 1 × 1.5 cm ulcer with a necrotic base which bled easily on contact with no evidence of peripheral neuropathy nor arterial insufficiency. Microscopic examination of a biopsy of the lesion showed fascicles of spindle cells with plump nuclei and intracytoplasmic yellow-brown pigment. Immunohistochemistry confirmed a diagnosis of melanoma. Discussion. There should be a high index of suspicion of malignancy with nonhealing diabetic ulcer especially when coupled with short disease duration. This case highlights the importance of a biopsy and histological evaluation in ulcers presenting in recently diagnosed diabetics with no evidence of peripheral neuropathy or vascular disease. Melanoma should be considered in spindle cell lesions especially with pigment and residual nevus cells.
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NewsBot · Jun 3, 2021

Malignant Tumours Presenting as Chronic Leg or Foot Ulcers
Frédéric Toussaint et al
J Clin Med. 2021 May 22;10(11):2251

Our purpose was to collect data on the incidence of malignant skin tumours presenting as chronic leg or foot ulcers in a tertiary centre, and to analyse the frequency and type of initial clinical misdiagnoses in these cases. A retrospective chart review of cases with melanoma or other malignant neoplasms of the skin of the lower extremity treated in a tertiary centre during January 2010 until February 2020 was conducted to identify cases that presented as chronic ulcers. Out of 673 cases, 26 (3.9%) were identified with a total of 27 malignant tumours presenting as chronic ulcers of the lower leg or foot. Therefrom, seven were diagnosed as melanoma, eight as squamous cell carcinoma, and twelve as basal cell carcinoma. The mean interval until diagnosis for all tumour types was 44.4 months (median 24 months). A delay in correct treatment occurred in 12 out of 26 cases (46%) as a result of misdiagnosis with subsequent treatment as chronic leg or foot ulcers of a different etiology. Misdiagnoses were venous ulcer, traumatic wound, mixed arterial and venous ulcer, arterial ulcer, and ulcer of an unknown origin. Malignant ulcers presenting as chronic ulcers are rare, but often lead to misdiagnosis.
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NewsBot · Jul 17, 2021

When acral malignant melanoma facades as diabetic foot!
Zainab Akram Yousif Yasear et al
BMJ Case Rep. 2021 Jul 15;14(7)

An 85-year-old Indian man presented with non-healing foot ulcer over the left heel. There was initial response to wound size with standard treatment including offloading, debridement and antibiotic therapy. However, subsequently, there was no progress noted. Incidentally, two small black spots in the wound bed raised the suspicion of melanoma. Incisional biopsy confirmed acral lentiginous melanoma (ALM). The final diagnosis was ALM coexisting with diabetic foot ulcer (DFU). The wound was treated by surgical resection and flap reconstruction that resulted in complete healing. Fourteen months after the initial intervention, the patient developed a new lump and ulceration around the previous wound bed. This turned out to be recurrent disease with distant metastasis. The patient died eventually with palliative support. Through this case, we would like to highlight the importance of early biopsy and intervention in DFU especially for those wounds with atypical presentation or refractory to standard treatment.
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NewsBot · Nov 9, 2021

Misdiagnosis of diabetic foot ulcer in patients with undiagnosed skin malignancies
Alexey V Lyundup et al
Int Wound J. 2021 Oct 29

A growing number of studies report dermal malignancies mimicking diabetic foot ulcers (DFUs). We reviewed clinical cases reporting malignant tumours misdiagnosed to be DFU aiming to identify factors contributing to misdiagnosis. We systematically searched in PubMed for clinical cases reporting on misdiagnosis of DFU in patients with cancer. A chi-square analysis was conducted to show the link between the incidence of initial DFU misdiagnosis and patient age, gender and wound duration. Lesions misdiagnosed to be DFU were subsequently diagnosed as melanoma (68% of the cases), Kaposi's sarcoma (14%), squamous cell carcinoma (11%), mantle cell lymphoma, and diffuse B-cell lymphoma (both by 4%). Older age (≥65 years) was associated with a significantly increased risk of malignancy masked as DFU (OR: 2.452; 95% CI: 1.132 to 5.312; P value = .019). The risk of such suspicion in older patients (age ≥ 65 years) was 145% higher than in younger patients (age < 65 years). Clinicians should maintain a high level of awareness towards potentially malignant foot lesions in elderly patients with diabetes (age ≥ 65).
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NewsBot · Jan 13, 2022

Therapy Delayed is Therapy Denied: A Case Report of Melanoma Misdiagnosed as Diabetic Foot Ulcer
Lawrence Chukwudi Nwabudike et al
Clin Cosmet Investig Dermatol. 2021 Dec 29

Malignant melanoma is a deadly form of skin cancer, and prompt diagnosis is a key factor in providing adequate, life-saving therapy. A 75-year-old man, with long-standing type 2 diabetes mellitus, presented with a 2- to 3-year history of right heel ulcer. He had received various therapies for a diagnosis of diabetic foot ulcer, to no avail. Physical examination showed a black, fungating ulcerated lesion on his right heel, with minimal bleeding. No inguinal lymphadenopathy was palpated. A biopsy was done, which revealed BRAF-negative malignant melanoma, with a vertical growth phase, Breslow 3.1 mm, ulceration, 11 mitoses/mm2, Clark level IV, no lymphatic or vascular invasion observed. Right inguinal lymph node sampling suggested no involvement, but PET-CT suggested pulmonary, right inguinal lymph node and bone involvement. The patient was referred to the oncologists. Written informed consent for publication was given by the patient. Diabetic foot ulcers are a frequently encountered, but serious complication of diabetes mellitus. Delayed healing is often seen, despite adequate therapy. The differential diagnosis of diabetic foot ulcers is vast and includes neoplasia. When a foot ulcer fails to heal, other differential diagnoses must be considered, in order for the patient to receive adequate therapy. Here specialist consultations, including dermatology consultations, could improve chances of delivering the right therapy promptly. This is a factor underlying the emphasis on a multidisciplinary approach to foot ulcer therapy. Our presentation - reported according to the CARE guidelines - also illustrates the fact that failure to reach a timely diagnosis may deny the patient the opportunity to receive adequate treatment. In such cases, "delayed therapy becomes denied (or failed) therapy", paraphrasing the old adage "Justice delayed is justice denied".
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NewsBot · Aug 9, 2022

Acral Amelanotic Melanoma Mimicking a Foot Ulcer
Harrison J Shawa et al
Cureus. 2022 Jul 6;14(7):e26615.

Acral amelanotic melanoma can be difficult to diagnose and is often clinically aggressive. The present report describes a case of an acral amelanotic melanoma presenting as a non-healing wound after mimicking a plantar wart for two years. The decision to biopsy a borderline-suspicious lesion on the lower extremity in an elderly individual must be weighed carefully, as lower extremity biopsy carries a risk of poor wound healing and other complications. We discuss clinical and epidemiologic features that can assist in deciding when to perform a biopsy in this setting and can improve the early detection of acral amelanotic melanoma.
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NewsBot · Jun 6, 2023

Malignant Melanoma Misdiagnosed as Diabetic Foot Ulcer
Junaid Hassan & Safeera Khan
Chapter 31 May 2023

Malignant melanoma is the most invasive skin cancer that is often misdiagnosed because of its atypical presentations and the presence of other comorbidities. Most of the deaths caused by skin cancers are because of malignant melanoma. Malignant melanoma may present as an ulcer associated with several other conditions like vascular and diabetic foot ulcers. If the ulcer doesn’t fit the diagnostic criteria of malignant melanoma or has other associated symptoms, malignant melanoma can be misdiagnosed as other benign ulcers. It is curable if diagnosed early, and resection with adequate margins is done. However, if diagnosed late or misdiagnosed, it may delay the treatment and decrease the 5-year survival of the patient and metastasis. Diabetes is a common condition and, if it remains uncontrolled, may present as diabetic foot ulcers. A high index of suspicion is needed to avoid these pitfalls in the presence of other comorbidities.
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NewsBot · Jan 8, 2024

Vasculitis-panniculitis mimicking unresolved diabetic foot ulcer
Debby Christiana Soemitha et al
Endocrinol Diabetes Metab Case Rep. 2024 Jan 8;2024(1):22-0397

Summary: Diabetes foot ulcer (DFU) is a common long-term complication of diabetes. Intractable chronic wounds to standard care of diabetic foot raise the question of whether other factors intervene in disease development. We report a case of a 54-year-old male patient who came to Sardjito General Hospital with leg pain and previous history of multiple debridement and amputation for DFU referred from a remote hospital yet no improvement was evident in the surrounding lesion following treatment. Consequently, a histopathological examination was carried out proving the presence of other aetiologic factors, vasculitis and panniculitis existing in the lesion. In this case, we report a rare type of causative factor of foot ulcers among diabetic patients. Vasculitis suspected for polyarteritis nodosa accompanied by panniculitis is considered in this patient. The treatment of choice is corticosteroids or immunosuppressants based on the clinical condition, contrary to usual wound care in DFU. Based on the evidence, clinicians need to consider other causes than only macrovascular complications in a diabetic patient with DFU that is intractable to standard wound care. In this patient, vasculitis may be considered in forming diabetic foot ulcers alongside macrovascular complications.

Learning points: A thorough examination is essential to rule out other processes in intractable DFU patients. Prompt management based on proper diagnosis is crucial to prevent peripheral arterial disease complications. Vasculitis and macrovascular complication are inseparable processes forming DFU in this patient.
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NewsBot · Apr 15, 2024

Misdiagnosis of cutaneous epithelioid angiosarcoma as diabetic foot ulcer: a case study
Yousef Almheirat et al
Wounds. 2024 Feb;36(2):43-46.

Background: AS is a malignant tumor that originates from vascular endothelial cells and is known for a high rate of local recurrence and metastasis.

Case report: A 48-year-old male presented with cutaneous epithelioid AS. Cutaneous AS of the foot is quite rare, especially in the absence of predisposing factors, and in this patient it was previously misdiagnosed as a DFU.

Conclusion: Physicians should be aware of this rare presentation of cutaneous AS. The authors of the current report advise regular clinical reassessment of chronic ulcers and biopsies of nonhealing wounds, even when adequate wound treatment has been administered, with the goal of identifying ulcerated skin malignancies and preventing delay in providing appropriate treatment.
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Verruca --- malignant melanoma

Melanoma

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Subungual/ feet Melanoma Mortality rates in Australia

bpac NZ Journal for Primary Healthcare and article Melanoma

Melanoma of the foot

Dermoscopy as a technique for the early identification of foot melanoma

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