Cancer and Amputation within Podiatry....

[mrjbb]

Please excuse my ignorance however this subject really interest me and I wanted to know:

How can a pod (If possible) treat cancer that originated in the foot/ankle area however hasn't spread to upper-extremities yet?

Would he/she refer the pt to an oncologist and completely disconnect themselves from any medical relevant issues associated with pt, give the patient a complete consultation OR try to work side by side with the onco in order to treat the ailment?

And I know that pods in some states still have full privileges of foot, ankle and leg (mid-leg), while some only have foot/ankle privileges but up to where or up to what area of leg can a pod surgeon perform amputations?

Amputation might be needed because of severe infection/diabetic associated problems.

Some insight please? Thanks...

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[NatCh]

Personally I've only encountered a malignant tumor in the foot once. I got on the phone and called the referring PCP, who then consulted the Oncologist. PCP's appreciate being kept in the loop since they're the hub of the wheel, so-to-speak.

If you diagnose a malignancy consult anyone and everyone who might be able to help the patient. It's no longer about privileges and scope of practice.

Nat

 

[mrjbb]

Yeah... Thank you. I guess as a pod if you encounter a tumor there's not a whole lot you can do except contact their primary physicians which in fact is enough to help the pt at that time.....

I was just curious as to what a pod might do when cancer was present...You have answered that area of my question.

 

[NatCh]

Yeah... Thank you. I guess as a pod if you encounter a tumor there's not a whole lot you can do except contact their primary physicians which in fact is enough to help the pt at that time.....

I was just curious as to what a pod might do when cancer was present...You have answered that area of my question.

If the tumor is isolated to the foot, then the DPM may be the one to surgically remove it. What I meant is that a malignancy is not something you'd want to treat in isolation. Is chemotherapy indicated? Is radiation indicated? Are there metastases elsewhere in the body? Get everyone on board who might do the patient some good.

 

[krabmas]

my attending told me about a patient that she saw the other day.

patient presents to office with non-healing ulcer on plantar heel for about 1 year. Patient is 52 yo female with no health problems.

diagnosis after biopsy - melanoma clark's level 4. referred back to PCP then oncology.

chest x-ray - mass in lower lobe. (this was ordered by the pod)

pet scan - metastisis to spine, pelvis, lungs, inguinal lymph nodes

Patient will be getting palliative care and will die. There may be some radiation therapy but more for ******ation of growth and to control pain of masses than to save her life.

Many cancers are benign tumors that are removed by the podiatrist. Removal of a soft tissue mass or any type of mass must be done carefully and typically if the lesion appears abnormal the margins must be marked. If the lesion is metastatic and the margins are not marked a much wider excision must be performed at a later time. In the foot a wide margin could mean the entire foot.

For clark's level 4 a 5cm (I think) margin must be removed with the lesion. In the foot that is the full thickness of the forefoot.

Orthopedic oncologists are typically the people that would take over the case for pedal cancers.

Most podiatrists are not up to date with chemotheraputic regimens.

 

[mrjbb]

Thank You all... You've helped a lot.. I appreciate your answers..

 

[densmore22]

my attending told me about a patient that she saw the other day.

patient presents to office with non-healing ulcer on plantar heel for about 1 year. Patient is 52 yo female with no health problems.

diagnosis after biopsy - melanoma clark's level 4. referred back to PCP then oncology.

chest x-ray - mass in lower lobe. (this was ordered by the pod)

pet scan - metastisis to spine, pelvis, lungs, inguinal lymph nodes

Patient will be getting palliative care and will die. There may be some radiation therapy but more for ******ation of growth and to control pain of masses than to save her life.

Many cancers are benign tumors that are removed by the podiatrist. Removal of a soft tissue mass or any type of mass must be done carefully and typically if the lesion appears abnormal the margins must be marked. If the lesion is metastatic and the margins are not marked a much wider excision must be performed at a later time. In the foot a wide margin could mean the entire foot.

For clark's level 4 a 5cm (I think) margin must be removed with the lesion. In the foot that is the full thickness of the forefoot.

Orthopedic oncologists are typically the people that would take over the case for pedal cancers.

Most podiatrists are not up to date with chemotheraputic regimens.

We just had Dr. Bakodic come and give a lecture about melanoma of the foot. It was an amazing presentation. That's too bad about that patient, makes you question if you drug your feet (no pun intended) on the diagnosis, but I seriously doubt it. Sounds like your attending followed proper protocol. I'll never forget some of the stuff he presented.

 

[FeetforLife]

I currently work at a dermatologist office, and being that I am in the process of becoming a podiatrist, I get to see a lot of basal and squamous cell carcinomas...as well as Melanoma's on the lower extremity. Once the patient's biopsy proves to be a melanoma, the patient's network of doctor's are notified. Tests are performed to search for any metastatic growth immediately.

Most of the BCC's/SCC's are removed either through excision or Moh's Micrographic Surgery, depending on the location of the lesion by the derms at my work. My question is if podiatrists are able to perform the same excisions if the carcinoma is located within the geography of the lower extremity.

Are there any podiatrists that specialize in dermatology? Derm is one of the aspects I like about podiatry, and I love that I already have a head start in clinical experience!

 

[krabmas]

I currently work at a dermatologist office, and being that I am in the process of becoming a podiatrist, I get to see a lot of basal and squamous cell carcinomas...as well as Melanoma's on the lower extremity. Once the patient's biopsy proves to be a melanoma, the patient's network of doctor's are notified. Tests are performed to search for any metastatic growth immediately.

Most of the BCC's/SCC's are removed either through excision or Moh's Micrographic Surgery, depending on the location of the lesion by the derms at my work. My question is if podiatrists are able to perform the same excisions if the carcinoma is located within the geography of the lower extremity.

Are there any podiatrists that specialize in dermatology? Derm is one of the aspects I like about podiatry, and I love that I already have a head start in clinical experience!

yes. dr. bakotik is a dpm, do that specializes in derm. he has his own lab and works in florida.

and dr. markinson is a dpm that specializes in derm. he works in nyc at mssm.