Malignant transformation in diabetic foot ulcers: A cross-sectional analysis of the impact of pathology results on patient management after diabetic foot surgery.
8 affiliations
- 1Department of Oncology Nursing, Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey.
- 2Department of Medical Pathology Laboratory, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
- 3Department of General Surgery, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
- 4Department of General Surgery, Etlik City Hospital, Ankara, Turkey.
- 5Department of Infectious Diseases and Clinical Microbiology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
- 6Department of Orthopedics, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
- 7Department of Endocrinology and Metabolic Diseases, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
- 8Department of Surgical Oncology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey.
Abstract
Diabetic foot ulcers (DFUs) are a major cause of lower-extremity amputation, hospitalization, and mortality. Although management focuses on wound care, infection control, and limb preservation, malignancies may develop in chronic, nonhealing wounds, and tumors may mimic DFUs. Evidence on malignancy in DFUs is limited, and the diagnostic contribution of routine histopathological examination in surgically treated cases remains unclear. This study aimed to determine the frequency of histopathologically confirmed malignancy in patients undergoing surgery for chronic DFUs and assess its impact on management and care. This retrospective, cross-sectional, single-center study was conducted at a Training and Research Hospital. We included 678 consecutive patients admitted with chronic DFUs between January 2019 and June 2021 who underwent surgical treatment and histopathological examination. Patients managed conservatively and those without a pathology specimen were excluded. Demographic characteristics, ulcer features, surgical procedures, histopathological findings, and changes in treatment and care were obtained from medical records. Statistical analyses were performed using SPSS version 25.0. The malignancy rate and its 95% confidence interval (CI) were calculated using the Clopper-Pearson method. A total of 678 patients were included. Of these, 74% were male, and the mean age was 64.69 ± 10.92 years. Wagner grade 4 ulcers accounted for 61.7% of cases, while 65.0% were classified as PEDIS grade 3. Histopathological examination identified malignancy in 4 patients (0.6%; 95% CI, 0.16-1.50); two of these patients had metastatic involvement. The treatment and care plan was modified for all patients in whom malignancy was detected. Overall, 95.6% of patients healed with wound care after surgery, without further changes to their treatment or care plan. However, 1.9% required amputation at a more proximal level, 1.3% experienced limb loss, and 1.2% died from other diabetes-related complications. Although uncommon, malignancy and metastatic involvement may occur in chronic DFUs. The possibility of malignancy should therefore be considered, particularly in nonhealing, atypical, or clinically suspicious ulcers. Ensuring appropriate histopathological evaluation of such ulcers may help healthcare professionals and wound care nurses identify primary or metastatic malignancies at an earlier stage.
Related
- Pancreatic solid papillary neoplasm with high-grade malignant transformation and multiple hepatic metastases in an elderly male: a case report
- Copper homeostasis dysregulation promotes malignant transformation of renal tubular epithelial cells via the ROS/NF-κB/AID signaling axis
- Triple Renal Pathology in a Patient With Myeloperoxidase-Associated Vasculitis, Diabetic Nephropathy, and Immunoglobulin A Nephropathy: A Case Report
- Spatially resolved gene expression and tumour-microenvironment interactions across malignant transformation in IDH-mutant glioma
- Malignant transformation of intraductal papillary neoplasm of the bile duct following non-standardized biliary-enteric drainage for hepatolithiasis: two case reports and literature review
BibTeX
@article{akyuz2026malignant,
title = {{Malignant transformation in diabetic foot ulcers: A cross-sectional analysis of the impact of pathology results on patient management after diabetic foot surgery.}},
author = {Simay Akyüz and Duygu Bayram and Yasin Gülap and Hikmet Erhan Güven and Melih Akinci and Aysun Yalçi and Ali Murat Başak and Neşe Ersöz Gülçelik and Mehmet Ali Gülçelik and Kerim Bora Yilmaz},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051242},
url = {https://europepmc.org/article/MED/42888623},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Malignant transformation in diabetic foot ulcers: A cross-sectional analysis of the impact of pathology results on patient management after diabetic foot surgery.
AU - Simay Akyüz
AU - Duygu Bayram
AU - Yasin Gülap
AU - Hikmet Erhan Güven
AU - Melih Akinci
AU - Aysun Yalçi
AU - Ali Murat Başak
AU - Neşe Ersöz Gülçelik
AU - Mehmet Ali Gülçelik
AU - Kerim Bora Yilmaz
PY - 2026
DA - 2026/10/01
JO - Medicine
DO - 10.1097/md.0000000000051242
UR - https://europepmc.org/article/MED/42888623
AB - Diabetic foot ulcers (DFUs) are a major cause of lower-extremity amputation, hospitalization, and mortality. Although management focuses on wound care, infection control, and limb preservation, malignancies may develop in chronic, nonhealing wounds, and tumors may mimic DFUs. Evidence on malignancy in DFUs is limited, and the diagnostic contribution of routine histopathological examination in surgically treated cases remains unclear. This study aimed to determine the frequency of histopathologically confirmed malignancy in patients undergoing surgery for chronic DFUs and assess its impact on management and care. This retrospective, cross-sectional, single-center study was conducted at a Training and Research Hospital. We included 678 consecutive patients admitted with chronic DFUs between January 2019 and June 2021 who underwent surgical treatment and histopathological examination. Patients managed conservatively and those without a pathology specimen were excluded. Demographic characteristics, ulcer features, surgical procedures, histopathological findings, and changes in treatment and care were obtained from medical records. Statistical analyses were performed using SPSS version 25.0. The malignancy rate and its 95% confidence interval (CI) were calculated using the Clopper-Pearson method. A total of 678 patients were included. Of these, 74% were male, and the mean age was 64.69 ± 10.92 years. Wagner grade 4 ulcers accounted for 61.7% of cases, while 65.0% were classified as PEDIS grade 3. Histopathological examination identified malignancy in 4 patients (0.6%; 95% CI, 0.16-1.50); two of these patients had metastatic involvement. The treatment and care plan was modified for all patients in whom malignancy was detected. Overall, 95.6% of patients healed with wound care after surgery, without further changes to their treatment or care plan. However, 1.9% required amputation at a more proximal level, 1.3% experienced limb loss, and 1.2% died from other diabetes-related complications. Although uncommon, malignancy and metastatic involvement may occur in chronic DFUs. The possibility of malignancy should therefore be considered, particularly in nonhealing, atypical, or clinically suspicious ulcers. Ensuring appropriate histopathological evaluation of such ulcers may help healthcare professionals and wound care nurses identify primary or metastatic malignancies at an earlier stage.
SN - 0304-5412
SN - 1536-5964
ER -