Acral Amelanotic Melanoma Mimicking a Non-Healing Arterial Ulcer

Abstract

Acral melanomas contribute to approximately 2–3% of melanomas but are commonly misdiagnosed due to their rarity, subtlety at onset and tendency to display amelanotic features. This case report describes a 70-year-old male with an amelanotic melanoma misdiagnosed as a non-healing arterial ulcer. Histopathology demonstrated a Breslow 2.3 mm, Clark level IV acral lentiginous melanoma, which was definitively managed with surgical intervention. This case report highlights the importance of considering melanoma in the differential diagnosis of non-healing ulcers.

Dermoscopy for Cutaneous Melanoma: under the eye of both the dermatologist and the legal doctor

“…Unfortunately, even with dermoscopy, some melanomas remain clinically and dermoscopically indistinguishable from other lesions, such as seborrheic keratoses, whose suggestive features might be displayed in up to 18% of melanomas, vascular lesions and pyogenic granulomas, lichen planus-like keratoses, warts, dermatofibromas, ulcers and, finally, from melanocytic nevi, hence difficult to diagnose [8][9][10][11][12][13][14][15][16]. This is particularly true in patients with atypical mole syndrome, whose nevi share clinically some, or all, the features of CM (the ABCDs: asymmetry, border, irregularity, color variability, and diameter > 6 mm).…”

Acral Amelanotic Melanoma

“…Acral melanomas are rare, 1 representing 2% -3% of all melanomas. 2 However, the fatality rate is higher because of delayed diagnosis. [1][2][3] They are more common on weight-bearing areas of the foot 2,4,5 and are frequently amelanotic sometimes mimicking fungal infections, diabetic foot ulcers or even plantar warts.…”

“…[1][2][3] They are more common on weight-bearing areas of the foot 2,4,5 and are frequently amelanotic sometimes mimicking fungal infections, diabetic foot ulcers or even plantar warts. [1][2][3] A 66-year-old woman was seen for a seven-month history of asymptomatic and ulcerated pink nodules, located on her left calcaneus. The lesions had developed spontaneously, and she was receiving wound care treatment for the last three months with no improvement.…”

“…Surgery is the definitive treatment for early-stage disease while medical management is generally reserved for adjuvant treatment. 2,3…”