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

Ömer Arda Çetinkaya

doi:10.4274/atfm.galenos.2019.70894

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

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 threepatients; one was localized in the heel region. Threepatients 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

Ethical Statement

Etik Kurul Onayı: Retrospektif çalışma. Hasta Onayı: Retrospektif çalışma. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir. Finansal Destek: Yazar, bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemiştir.

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 cancerrelated 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 welldifferentiated 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.

Details

Primary Language

English

Subjects

General Surgery

Journal Section

Research Article

Authors

Ömer Arda Çetinkaya ^*
0000-0001-9135-8224
Türkiye

Publication Date

October 23, 2020

Submission Date

October 8, 2019

Acceptance Date

December 16, 2019

Published in Issue

Year 2019 Volume: 72 Number: 3

DOI

https://doi.org/10.4274/atfm.galenos.2019.70894

IZ

https://izlik.org/JA92NK98AG

Cite

RIS / Bibtex

APA

Çetinkaya, Ö. A. (2020). 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. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 72(3), 334-338. https://doi.org/10.4274/atfm.galenos.2019.70894

AMA

1.Çetinkaya ÖA. 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. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72(3):334-338. doi:10.4274/atfm.galenos.2019.70894

Chicago

Çetinkaya, Ömer Arda. 2020. “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”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 (3): 334-38. https://doi.org/10.4274/atfm.galenos.2019.70894.

EndNote

Çetinkaya ÖA (October 1, 2020) 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. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72 3 334–338.

IEEE

[1]Ö. A. Çetinkaya, “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”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 72, no. 3, pp. 334–338, Oct. 2020, doi: 10.4274/atfm.galenos.2019.70894.

ISNAD

Çetinkaya, Ömer Arda. “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”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 72/3 (October 1, 2020): 334-338. https://doi.org/10.4274/atfm.galenos.2019.70894.

JAMA

1.Çetinkaya ÖA. 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. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;72:334–338.

MLA

Çetinkaya, Ömer Arda. “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”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 72, no. 3, Oct. 2020, pp. 334-8, doi:10.4274/atfm.galenos.2019.70894.

Vancouver

1.Ömer Arda Çetinkaya. 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. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020 Oct. 1;72(3):334-8. doi:10.4274/atfm.galenos.2019.70894