从伪装成神经性足跟溃疡的侵袭性肿瘤中汲取的教训:病例报告。

IF 1.5 4区 医学 Q3 DERMATOLOGY
Qusai AlJarrah, Arafat M Hammad, Bana Eyad Shehadeh, Mohammad AlQudah, Ahmad K Abou-Foul
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引用次数: 0

摘要

皮肤恶性黑色素瘤(cMM)可发生在任何部位,但有三分之一的病例主要累及下肢,其中踝关节和足部病变占所有病例的 3-15%。然而,如果 cMM 表现为慢性溃疡,而临床上又无法将其与糖尿病患者的其他下肢溃疡区分开来,这可能会成为临床难题。我们介绍了一例71岁的女性患者,她长期患有糖尿病、高血压、肥胖症、慢性肾脏病和心力衰竭。该病变最初在另一家医院作为神经性糖尿病足溃疡(DFU)处理,通过多次局部伤口清创治疗。然而,溃疡发展成为足跟真菌病变,影响了患者的活动能力和生活质量。因此,患者被转诊到我们的糖尿病足专科接受进一步治疗。对病灶进行切除活检后发现了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肿大,右脑转移,并开始接受姑息化疗。曾考虑采用免疫疗法,但在开始之前患者就已经死亡。糖尿病患者的非典型足部溃疡需要仔细诊断,尤其是对标准疗法无效的顽固性皮肤病变。如果能认真对待,不过度拖延组织病理学诊断,就有可能及早诊断出黑色素瘤,从而获得更有利的治疗效果。本病例强调了在普通诊所和转诊中心考虑非典型足部病变的重要性,以努力识别令人担忧的特征并采取相应行动。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lessons learnt from an aggressive tumour masquerading as a neuropathic heel ulcer: a case report.

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.

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来源期刊
Journal of wound care
Journal of wound care DERMATOLOGY-
CiteScore
2.90
自引率
10.50%
发文量
215
期刊介绍: Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.
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