SLR - February 2022 - John A. Cameron
Reference: Lyundup AV, Balyasin MV, Maksimova NV, Kovina MV, Krasheninnikov ME, Dyuzheva TG, Yakovenko SA, Appolonova SA, Schiöth HB, Klabukov ID. Misdiagnosis of Diabetic Foot Ulcer in Patents with Undiagnosed Skin Malignancies. Int Wound J. 2021 Oct 29. doi: 10.1111/iwj.13688. Epub ahead of print. PMID: 34713964.Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: John A. Cameron, DPM
Residency Program: East Liverpool City Hospital – East Liverpool, OH
Podiatry Relevance: Wound care and the management of diabetic foot ulcerations (DFUs) is an integral part of practice for the podiatric physician. As routine as DFU management may seem to a podiatric physician, it is our job to ensure the healing potential of our patients is optimal. Also, it is important to remain diligent for instances where malignant etiologies of pedal ulcerations must be ruled out. This is especially true in certain patient demographics where healing is not progressing as expected.
Methods: A systematic review was conducted to identify articles across a variety of databases which reported on instances where malignancies were misdiagnosed as DFUs. Key words were used to perform a multi-database search to identify instances of sinister tumors, instances of misdiagnosed malignant tumors, and the specific site and nature of the lesions involved. Data extracted from these studies pertained to malignancy type, number of patients, type of diabetes mellitus and duration of disease and presence of diabetic complications, wound description and duration. Several statistical analyses were performed to draw conclusions from the data.
Results: A total of 384 articles were obtained and reviewed which yielded a total of 28 reported instances of malignancies originally misdiagnosed as DFUs. The official pathology result of the misdiagnosed malignancies was melanoma in (19 patients), Kaposi’s sarcoma (four patients), squamous cell carcinoma (three patients), mantle cell lymphoma (one patient) and diffuse B cell lymphoma (one patient). All patients in the studies were known to suffer from diabetes. Twenty (20) patients suffered from Type II Diabetes Mellitus, and in eight (8) patients the form of diabetes was unspecified. The most notable finding of the study was that there was a significant association between the age of the patient and the incidence of the clinical suspicion of the DFU in patients with wounds of malignant nature.
Conclusions: The risk of misdiagnosis of DFU in patients with of wounds of malignant nature was found to be significantly higher in patients in patients with diabetes mellitus aged 65 and older. The article suggests clinicians should be especially attentive when determining wound etiology in patients within this demographic. It should be considered good practice to have a low threshold to obtain biopsy of ulcerative lesions for all patients early in management, but this is especially true for patients in the demographic described to ensure malignancy is not being treated routinely as a diabetic foot ulceration. Should further care be indicated from other specialties timely identification and diagnosis is our responsibility to obtain the best possible prognosis for the patient.