Fatal squamous cell carcinoma from necrobiosis lipoidica diabeticorum in a diabetic patient. (14th March 2019)

• Record Type: Journal Article
• Authors: Lefkovits, Yael; Adler, Amanda
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2019)
• Publication Date: 2019-03-14
• Subjects: Adult -- Male -- White -- United Kingdom; Skin -- Diabetes -- Tumours and neoplasia -- Insulin -- Diabetes mellitus type 1; Diabetes mellitus type 1 -- Renal insufficiency -- Skin necrosis -- Fungating lesion -- Erythema -- Leg pain -- Chronic pain -- Malaise -- Weight loss -- Lymphadenitis -- Back pain -- Haemoglobin A1c -- Skin biopsy -- CT scan -- Fine needle aspiration biopsy -- Histopathology -- Amputation -- Radiotherapy -- Lymph node dissection -- Analgesics -- Insulin -- Corticosteroids; Nursing -- Podiatry -- Surgery; Error in diagnosis/pitfalls and caveats -- March -- 2019; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-19-0007
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: Necrobiosis lipoidica diabeticorum (NLD) is a chronic granulomatous dermatitis generally involving the anterior aspect of the shin, that arises in 0.3–1.2% of patients with diabetes mellitus (1 ). The lesions are often yellow or brown with telangiectatic plaque, a central area of atrophy and raised violaceous borders (2 ). Similar to other conditions with a high risk of scarring including burns, stasis ulcers and lupus vulgaris, NLD provides a favourable environment for squamous cell carcinoma (SCC) formation (3 ). A number of cases of SCC from NLD have been recorded (3, 4, 5 ); however, our search of the literature failed to identify any cases of either metastatic or fatal SCC which developed within an area of NLD. This article describes a patient with established type 1 diabetes mellitus who died from SCC which developed from an area of NLD present for over 10 years. Currently, there are a paucity of recommendations in the medical literature for screening people with NLD for the early diagnosis of SCC. We believe that clinicians should regard non-healing ulcers in the setting of NLD with a high index of clinical suspicion for SCC, and an early biopsy of such lesions should be recommended. Learning points: Non-healing, recalcitrant ulcers arising from necrobiosis lipoidica diabeticorum, which fail to heal by conservative measures, should be regarded with a high index of clinical suspicion for malignancy. If squamous cell carcinoma is suspected, a biopsy should be performed as soon as possible to prevent metastatic spread, amputation or even death. Our literature search failed to reveal specific recommendations for screening and follow-up of non-healing recalcitrant ulcers in the setting of necrobiosis lipoidica diabeticorum. Further research is required in this field.