Melanoma is a malignant tumor that is derived from melanocytes of the skin and other sites. Melanoma accounts for 1% to 3% of all malignancies and 1% to 2% of all cancer deaths worldwide. We are presenting a case of a 42-year-old female who presented to the surgery department with a growth over the right heel since 18 months, with a history of trauma to the site. The lesion showed rapid progression with a large mass and secondary skin ulceration and sloughing. A PET scan showed an enhancing lesion on the right heel measuring 11 mm in thickness. There was no evidence of any systemic organ or any lymph node metastasis. Surgical excision and reconstruction on the part of the heel by a local flap with sural graft with split-thickness skin grafting was done. The excised growth was sent for histopathology. The histopathological diagnosis of nodular melanoma (NM) of the heel was given. We are presenting this case for its clinical, histopathological, and surgical management.

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Introduction: Anemia is one of the most common nutritional deficiency condition affecting pregnant women, prevalence is 14% in developed countries, 51% in poor countries, and 65 to 75 %present in India. Anemia is the second leading cause of maternal death in India, accounting for nearly 80% of anemia-related maternal fatalities in Southeast Asia. Because of disparities in socioeconomic situations, lifestyles and health-seeking habits among countries, the prevalence of anemia in pregnancy varies significantly. Aim: To study occurrence of anemia in third trimester of pregnancy with its various causes and its impact on maternal and fetal outcome. Objectives: To study various etiological factors associated with anemia in third trimester of pregnancy. To study the outcome of mother and neonate born to them. Material & Methods: Present study was conducted in the Department of Pathology at Krishna Medical Research Center on blood samples received from 200 patients with anemia in the third trimester of pregnancy. Hematological (CBC, Peripheral smear, Reticulocyte count, Bone marrow aspiration, HPLC) and biochemical (Serum ferritin, Serum iron, TIBC, Vitamin B12) investigations were done. Data so collected was tabulated in an excel sheet and was analysed. Results: Out of 200 subjects, maximum cases were having age of 19-30 years (84%). 43% (86/200) had mild anemia, 48.5% (97/200) had moderate anemia and 8.5% (17/200) had severe anemia.63.5% (127/200) cases were unbooked and 36.5% (73/200) were booked under antenatal care in department of Obstetric and Gynecology of our tertiary care centre. In our study, 98% (196/200) of the cases were from rural areas. 55% (110/200) cases were from illiterate group and 45% (90/200) cases were from literate group. Majority of cases i.e. 43% (86/200) belonged to lower socioeconomic class (V). Maximum number of cases i.e. 78.5% (157/200) in this study were >37 weeks of gestation. Maximum number of cases in this study were primigravida. Iron deficiency is the most common cause of maternal anemia. Conclusion: The result from this study show that the commonest cause of maternal anemia in pregnancy was iron deficiency followed by vitamin B12/folate deficiency, comprising of majority of cases i.e. 98.5%. These are nutritional deficiencies which can be prevented and treated. From this study it can be concluded that the outcome of anemia in pregnancy depends upon the cause and the degree or severity of anemia. Hb estimation and peripheral smear examination can help to assess the severity of the anemia in pregnancy and thus can reduce both the maternal and fetal complications if detected and treated early. It is highly recommended that more effective guidelines regarding educating girl child, regular antenatal check ups, free provision and regular intake of iron-folic acid tablets, should start at grass-root levels to get safe motherhood. Key words: Anemia, Pregnant women, Third trimester, CBC.