Diabetes is a common and complex disease affecting multiple organ systems throughout the body. With a consensus in care guidelines emphasizing the importance of glycemic control in determining the disease progression, people with diabetes worldwide have been placed on medication regimens targeting glucose stability from a variety of pathophysiologic pathways. Each of these medications also possesses its own potential for adverse events. In recent years, there has been increased reports of skin reactions to diabetes medications, adding to the more widely known eruptions such as insulin-induced lipohypertrophy and contact dermatitis of subcutaneous injections. The authors searched PubMed, Google, and Embase for articles including adverse reactions to anti-hyperglycemic medications. Key words and titles searched included, “antidiabetic drugs”, “skin reactions”, “adverse drug reactions”, “allergic reactions”, “diabetes”, “metformin”, “insulin”, “DPP4 inhibitors”, “thiazolindineones”, “sulfonylureas”, “SGLT2 inhibitors”, “GLP-1 agonists”, “diabetic medication”, “injection site reactions”. As a result, a total of 59 papers are included in this review. The great majority were case reports ranging from benign fixed drug eruptions to severe cutaneous reactions that threaten patients’ lives. Increasing physician awareness of both the potential for, and presentation of, such reactions to diabetes medications can reduce hospitalizations and optimize care in an already vulnerable patient population.

Skin cancer is the most common cancer in the United States, with a disproportionate amount of cases diagnosed as basal and squamous cell carcinoma. While melanoma accounts for only a small fraction of all skin cancers, it has greater potential for invasion and metastasis if not identified and treated early. Within this higher mortality subtype of skin cancer, there is a rare variant called polypoid melanoma (PM) that compounds the diagnostic hardships of distinguishing melanomas from more benign lesions. This aggressive melanoma has a wide variety of clinical presentations that can range from an amelanotic, sessile papule to a pedunculated, melanotic nodule. Its growth pattern also contributes to the lesion’s ambiguity, generally undergoing a slow development period that can spontaneously transition into rapid growth. This can present challenges for all potential parties involved, including the patient, primary physicians, and dermatologists alike. Such characteristics can act as barriers in clinically determining the urgency of a biopsy, thereby affecting time to diagnosis and prognosis of their patients. We report one such case of protracted diagnosis of polypoid amelanotic melanoma due to a combination of aesthetic ambiguity and lack of patient proactivity.

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