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A Case of Diabetes Mellitus Type 2 Complicated with Malignant Melanoma Misdiagnosed as Diabetic Foot Ulcer
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摘要: 肢端型恶性黑色素瘤是我国黑色素瘤的主要类型，以足底病变多见。由于临床表现相似，易被误诊为糖尿病足溃疡等疾病。本文报道1例糖尿病合并恶性黑色素瘤患者，因足部溃疡被误诊为糖尿病足溃疡，从而延误了治疗。若糖尿病患者足部皮损表现为不典型溃疡且溃疡迁延不愈时，应行病理检查以排除恶性黑色素瘤的可能性。Abstract: Acral malignant melanoma, as the main type of melanoma in China, is commonly seen in plantar lesions. Due to similar clinical manifestation, it is easy to be misdiagnosed as diabetic foot ulcers. We report a case of diabetes mellitus complicated with malignant melanoma, which was misdiagnosed as diabetic ulcer in the right foot, thus delaying treatment. Therefore, when diabetic foot lesions are characterized by atypical ulcers and the foot ulcers remain unhealed, pathological examination should be performed to exclude the possibility of malignant melanoma.
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Key words:
- diabetes mellitus type 2 /
- malignant melanoma /
- diabetic foot ulcers
作者贡献：吴亚茹负责查阅文献，撰写论文；赵跃斌、刘师伟指导论文修订。利益冲突：无 -
图 2 患者入院后CT检查结果
A.头颅CT示右侧半卵圆中心腔隙性脑梗死；B.胸部CT示双肺间质改变伴条索影；C.腹部CT示肝硬化、脾大，胆囊未显示，胃周及腹腔内多发淋巴结，盆腔少量积液
图 3 患者右足底病变免疫组化结果(×100)
A.HE染色；B.S100染色阳性；C.SOX10染色阳性；D.Vimentin染色阳性；E.Melan-A染色阳性；F.HMB45染色阳性；G.肿瘤细胞部分Ki-67染色阳性
表 1 文献中糖尿病患者合并恶性黑色素瘤的临床特征(检索日期：2021年2月25日)
作者 性别 年龄(岁) 糖尿病病程(年) 部位 破溃时间 诱因 创面情况 创面大小 病理诊断 转移部位 色素斑 王璐宁等[7] 女 66 8 右足第一趾 1年 甲沟炎 类圆形创面，有脓血样分泌物 1.0 cm×1.5 cm 右足拇趾恶性黑色素瘤 双肺、肝脏、右侧腹股沟淋巴结 无 高小华等[8] 男 84 18 右足第一趾 5年 甲床破溃、流脓 右足拇趾发黑，触之易出血 - 右足拇趾恶性黑色素瘤 无 - 孙丽岩等[9] 女 66 8 右足第一趾 1年 甲沟炎 趾甲残端类圆形创面，有脓血性分泌物 1.5 cm×1.0 cm 恶性黑色素瘤 双肺转移、肝转移、腹股沟淋巴结 - 王淑敏等[10] 女 69 10 右足踇趾截趾术残端 9月余 - 创口处两个黄豆大小肿物，无触痛 1 cm×0.5 cm；2 cm×2 cm 足趾肿物恶性黑色素瘤 前哨淋巴结转移 - Hussin等[3] 男 80 40 左足第一趾 3个月 重物坠落受伤史 趾尖端肿块，周围皮肤无色素沉着 2 cm×2 cm 恶性黑色素瘤，无色素型 无 - 女 52 15 左足第四和第五跖骨底部 4个月 刺伤 溃疡周围有色素沉着 3 cm ×3 cm 恶性黑色素瘤，肢端雀斑样黑色素瘤 无 - 刘东等[11] 男 71 6 右足底 6个月 外伤 右小腿以下皮肤发黑，两处破溃 3 cm×2 cm1 cm×1 cm 右足背恶性黑色素瘤 淋巴结转移，双肺转移 无 右足跟部破溃 3 cm ×4 cm Zaidi等[12] 男 67 9 右足跟 9个月 鞋不合脚 圆形伴色素沉着、出血性溃疡 2 cm×2 cm 侵袭性恶性黑色素瘤 - - Gao等[13] 女 78 8 右足溃疡 6个月 - 两个溃疡，边缘、表面有色素沉着 直径均约0.5 cm 恶性黑色素瘤 无 - Gregson等[2] 女 76 15 右足第三跖骨底部 15年 - 无色素性溃疡 直径约1 cm 无色素性恶性黑色素瘤 右侧腹股沟淋巴结 - Torres等[14] 男 54 - 右足第五跖骨 12个月 - 溃疡边缘不规则 直径2.5 cm 恶性黑色素瘤 腹股沟淋巴结 有 Rogers等[15] 男 48 - 右足第一跖骨下 18个月 - 肉芽组织生长，表皮完整 3 cm× 3 cm 低分化黑色素瘤 肝脏、腹股沟淋巴结 - -：原文献中无相关描述 
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