Malignant transformation in diabetic foot ulcers: A cross-sectional analysis of the impact of pathology results on patient management after diabetic foot surgery.

Histopathological examination identified malignancy in 4 of 678 patients (0.6%) with chronic diabetic foot ulcers who underwent surgical treatment.

• Malignancy rate was 0.6% with a 95% CI of 0.16–1.50, calculated using the Clopper-Pearson method.
• Two of the four patients with malignancy had metastatic involvement.
• The treatment and care plan was modified for all 4 patients in whom malignancy was detected.
• The study included 678 consecutive patients admitted between January 2019 and June 2021 at a single Training and Research Hospital.

The study population was predominantly male, older, and presented with high-grade diabetic foot ulcers.

• 74% of the 678 patients were male.
• Mean age was 64.69 ± 10.92 years.
• Wagner grade 4 ulcers accounted for 61.7% of cases.
• 65.0% of ulcers were classified as PEDIS grade 3.

The majority of patients (95.6%) healed with wound care after surgery without further changes to their treatment or care plan.

• 95.6% of patients healed with wound care after surgery without further modifications to their treatment or care plan.
• 1.9% of patients required amputation at a more proximal level.
• 1.3% experienced limb loss.
• 1.2% died from other diabetes-related complications.

Patients managed conservatively and those without a pathology specimen were excluded from the study, limiting the sample to surgically treated cases with histopathological examination.

• The study was retrospective, cross-sectional, and conducted at a single center.
• Only patients undergoing surgical treatment and histopathological examination were included.
• Data collected included demographic characteristics, ulcer features, surgical procedures, histopathological findings, and changes in treatment and care from medical records.
• Statistical analyses were performed using SPSS version 25.0.

Malignancies in chronic diabetic foot ulcers may clinically mimic non-healing wounds, and histopathological evaluation of atypical or suspicious ulcers may enable earlier detection of primary or metastatic malignancies.

• Tumors may mimic diabetic foot ulcers clinically, making visual diagnosis alone insufficient.
• Two of the four identified malignancies involved metastatic disease, indicating potential for systemic spread.
• The authors note that evidence on malignancy in diabetic foot ulcers is limited and the diagnostic contribution of routine histopathological examination remains unclear.
• The authors recommend that the possibility of malignancy should be considered 'particularly in nonhealing, atypical, or clinically suspicious ulcers.'