Department of General and Vascular Surgery, King Abdullah University Hospital (KAUH), Jordan University of Science and Technology (JUST), Irbid, Jordan.
Faculty of Medicine, Jordan University of Science and Technology, Irbid-22110, Jordan.
J Wound Care. 2024 Jun 1;33(Sup6):S20-S24. doi: 10.12968/jowc.2022.0281.
Cutaneous malignant melanoma (cMM) can develop at any site, but one-third of cases primarily affect the lower extremities, with ankle and foot lesions representing 3-15% of all cases. However, cMM may become a clinical conundrum when it presents as chronic ulceration that is clinically indiscernible from other lower extremity ulcers in patients with diabetes. We present the case of a 71-year-old female patient with a longstanding history of diabetes, hypertension, obesity, chronic kidney disease and heart failure who presented to our hospital with a fungating heel ulcer. The lesion was initially managed in another hospital as a neuropathic diabetic foot ulcer (DFU), treated by multiple local wound debridement. However, the ulcer progressed into a fungating heel lesion that interfered with the patient's mobility and quality of life. Consequently, the patient was referred to our specialist diabetic foot service for further management. Excisional biopsy of the lesion disclosed a cMM. Positron emission tomography/computed-tomography scanning revealed hypermetabolic ipsilateral inguinal lymphadenopathy, and a right cerebral metastasis for which palliative chemotherapy was initiated. Immunotherapy was considered, but the patient died before it was started. Atypical foot ulcers in patients with diabetes warrant a careful diagnostic approach, especially for recalcitrant cutaneous lesions not responding to standard therapies. Conscientious management, without undue delay in obtaining a histopathological diagnosis, might lead to early diagnosis of melanoma and potentially more favourable outcomes. This case highlights the importance of consideration of atypical foot lesions, in general practice in addition to referral centres, to try to identify alarming features and act accordingly.
皮肤恶性黑色素瘤（cMM）可发生于任何部位，但三分之一的病例主要影响下肢，踝关节和足部病变占所有病例的 3-15%。然而，当 cMM 表现为慢性溃疡时，对于患有糖尿病的患者来说，其临床表现与其他下肢溃疡难以区分，这可能成为一个临床难题。我们报告了一例 71 岁女性患者，有长期糖尿病、高血压、肥胖、慢性肾脏病和心力衰竭病史，因足部溃烂来我院就诊。该病变最初在另一家医院被诊断为神经性糖尿病足溃疡（DFU），经多次局部清创处理。然而，溃疡进展为足部溃烂，严重影响了患者的活动能力和生活质量。因此，患者被转至我们的糖尿病足专科进行进一步治疗。病变的切除活检显示为 cMM。正电子发射断层扫描/计算机断层扫描显示同侧腹股沟淋巴结代谢活跃，右侧大脑转移，开始进行姑息性化疗。考虑进行免疫治疗，但患者在开始治疗前死亡。糖尿病患者的非典型足部溃疡需要仔细的诊断方法，尤其是对那些对标准治疗无反应的顽固皮肤病变。认真管理，避免延误获取组织病理学诊断，可能有助于早期诊断黑色素瘤，并获得更好的治疗效果。本病例强调了在一般实践和转诊中心都要考虑非典型足部病变的重要性，以识别出警示特征并采取相应的措施。
