SHM Converge Scientific Abstract ePoster Gallery-Melanoma Mimicking a Diabetic Foot Infection

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A 58-year-old man with type 2 diabetes, hypertension, peripheral arterial disease, and prior right fifth toe amputation for osteomyelitis presented with worsening pain at a chronic, non-healing right foot ulcer. The ulcer had originally been diagnosed as a diabetic foot infection two years earlier, but it persisted despite multiple antibiotic courses and improved glycemic control. He had also recently been hospitalized for ulcer management, including excisional debridement and anterior tibialis angioplasty.<br /><br />On presentation, he was tachycardic and had fluctuance around the plantar right foot ulcer. Examination also revealed a firm, tender right inguinal mass. Laboratory testing showed leukocytosis. Broad-spectrum antibiotics were started, but MRI demonstrated an enlarging 5 x 4 cm plantar soft tissue mass rather than a simple infection. He underwent wide local excision of the foot lesion with punch biopsies.<br /><br />Ultrasound of the inguinal mass suggested possible abscess, but it continued to enlarge despite IV antibiotics. Excisional biopsy of the inguinal lesion revealed metastatic malignant melanoma, matching the pathology from the right foot mass. This case illustrates how an apparent chronic diabetic foot ulcer that fails to heal despite appropriate treatment should raise concern for an underlying malignancy rather than persistent infection.

Asset Subtitle

Dennis P. Kurian

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Author List Amanda BonanoCarambot, Dennis P. Kurian, Erica Grabscheid, Karishma Vijay Rupani, Maria Riasat

Category Clinical Vignettes

Concept Diabetic Foot Ulcer

Concept Biopsy

Concept Malignant Melanoma

Concept Malignancy

Concept Soft Tissue Mass

Distinguished Non-Finalist

Presenter Organization NYU Langone

Presenting Author Dennis P. Kurian

Track Adult

Keywords

diabetic foot ulcer

malignant melanoma

metastatic melanoma

chronic non-healing wound

soft tissue mass

foot infection

inguinal mass

biopsy

osteomyelitis

peripheral arterial disease

Diabetic Foot Ulcer

Biopsy

Malignant Melanoma

Malignancy

Soft Tissue Mass