頁籤選單縮合
題名 | Verrucous Carcinoma Originating from a Diabetic Foot Ulcer: A Case Report=出現在糖尿病足的疣形癌--病例報告 |
---|---|
作者 | 吳曉舒; 林才民; 楊曉芳; 賴春生; Wu, Hsiao-su; Lin, Tsai-ming; Yang, Sheau-fang; Lai, Chung-sheng; |
期刊 | 中華民國整形外科醫學會雜誌 |
出版日期 | 20080900 |
卷期 | 17:3 2008.09[民97.09] |
頁次 | 頁282-287 |
分類號 | 415.75 |
語文 | eng |
關鍵詞 | Diabetic foot ulcer; Verrucous carcinoma; |
中文摘要 | 眾所皆知,在感覺缺損的皮膚上施以長期的刺激或摩擦,可能在皮膚上出現所謂的疣狀突起,尤其是在糖尿病神經病變的患者腳上,通常這種皮膚病變終究演變成臨床上常見的糖尿病足的慢性潰瘍。在此,我們提出一罕見由糖尿病足的疣形潰瘍癌化成疣形病的病例。 一名49歲的男性糖尿病患者,在兩年前曾因糖尿病足接受左足第三趾截肢及第二趾、第四趾死骨切除,八個前發現他的左足第二趾根部鄰近開刀疤痕處出處一疣形突起的潰瘍,而至本院門診求治。第一次皮膚切片報告認為是一良性狀瘤,在以多次局部削除疣狀表皮合併抗生素藥膏照護傷口下,病灶卻出現慢慢擴大的跡象,三個月後,病人接受第二次切片檢查,而被診斷為疣形癌。我們以廣泛性切除治療其惡性病灶且以全層皮瓣移植履蓋裸露的傷口。 臨床上面對糖尿病足的慢性潰瘍時,如果排除了感染或其他外界刺激因素,病灶仍不見改善而逐漸惡化時,就應考慮惡性疾病的可能性。預防勝於治療,在治療上我們可以積極地控制血糖及感染的狀況,只有懷疑有癌化的可能就應執行切片檢查的動作。 |
英文摘要 | Background: It has been well-documented that chronic pressure or friction in the area of sensory loss might cause verrucous skin lesions especially on the feet of diabetic neuropathy victims. However, malignant change of these skin lesions have not yet been frequently reported. We report here a rare case of verrucous carcinoma originating from a diabetic ulcer and review the literature. Case Presentation: A 49-year-old male is a victim of diabetes mellitus. Due to osteomvelitis, he had received left third toe amputation, left second metatarsal sequestrectomy, and fourth toe shortening at distal phalangeal shaft two years before admission. He noted a fungating ulceration on his left dorsal foot which was at the base of the second toe 8 months before his coming for help. Initial skin biopsy was done and preliminary pathology results revealed verruca vulgaris. However, the fungating mass enlarged even after several scalpel shavings with topical antibiotics ointment. A second skin biopsy was done 3 months later. Unfortunately, histology results showed verrucous carcinoma. Sectional margin-free wide excision was done and full thickness skin graft was used to cover the soft tissue defect. Conclusion: In treating chronic diabetic ulcers, the possibility of potentially malignant change of the wound must be taken into consideration once the lesions persist or aggravate without infection or other offending factors. Any violating infection should be controlled by aggressive antimicrobial therapy with surgical debridement. Further biopsy should be performed to clarify any suspected malignant changes. (J Plast Surg Asso R.O.C. 2008; 17:282~287) |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。