The Importance of Wound Biopsy in the Accurate Diagnosis of Acral Malignant Melanoma Presenting as a Foot Ulcer

Abstract

Neoplastic changes arising at the sites of chronic, nonhealing wounds are not uncommon; however, they often go undiagnosed. We report a case of rapidly progressing plantar melanoma presenting as a chronic, nonhealing ulcer. A 46-year-old patient presented at a specialized Wound Healing Center with an enlarging painful ulcer on the right heel of 3 months duration. The wound was biopsied and specimens were sent for examination at the Wound Pathology service at the Department of Dermatology and Cutaneous Surgery, University of Miami. Histology demonstrated features consistent with acral malignant melanoma. Immunohistochemistry using melanocytic markers MART-1, S-100, HMB-45 revealed positive staining indicating the presence of malignant cells, and D2-40 staining showed lymphatic invasion of the tumor in the wound biopsy specimen. The case presented here underscores the importance of wound biopsying in the diagnosis of malignancies associated with nonhealing wounds.

Malignant wounds: Basal cell carcinoma presenting as a nonhealing ulceration on an arteriovenous fistula

“…1,2 Vascular invasion is considered a major prerequisite for metastatic invasion. 5 There are different treatment modalities depending on the clinical aspect, size, location, histological subtype, and patient characteristics: curettage, electrodesiccation, surgical excision, Mohs surgery, cryosurgery, topical chemotherapy, photodynamic therapy, or even radiotherapy. 2,6 Apparently, surgical removal with safety margins is the most effective option when preserving perilesional tissue is not a priority.…”

“…2,5,7 For all the things considered, a high degree of suspicion is essential in nonhealing ulcers. 5,8…”

“…However, the diagnosis of certainty is reached with histological examination of the sample, after performing skin biopsy. 2,5 Treatment depends on the characteristics of the tumor and the patient, and it may vary from curettage to surgical excision. Its objective is to remove cancer completely, preserving as much as possible the functionality and aesthetics of the region involved.…”

Acral Amelanotic Melanoma Mimicking a Non-Healing Arterial Ulcer

“…Acral melanomas contribute to approximately 2–3% of melanomas and do not always exhibit the classical signs associated with malignant melanoma (asymmetry, border irregularity, colour variance, diameter) [1]. Acral melanomas are more common in weight-bearing areas of the foot [2], including the front of the foot, where our patient's melanoma was identified.…”

A rare case of acral amelanotic melanoma, nodular type

“…Acral acral amelanotic malignant melanoma (aMM) is rare type of melanoma and it is easily overlooked, leading to a delayed diagnosis. Acral aMM usually presents as an erythematous nodule or plaque and is often clinically misdiagnosed as a benign lesion initially . Unfortunately, because of delayed diagnosis, this malignancy is usually diagnosed at an advanced stage with nodal metastasis and is associated with a poor prognosis …”