Acral melanoma with hyperkeratosis mimicking a pigmented wart

Abstract

Acral lentiginous melanoma (ALM) of the sole sometimes has a hyperkeratotic appearance and mimics a pigmented wart. We report a case of an 81-year-old woman with an ALM on the left sole with hyperkeratosis. Due to its presentation it was difficult to make a correct diagnosis at the beginning. Finally we noticed several small, pigmented macules around the wart-like lesion with the parallel ridge pattern on dermoscopy, strongly suggesting acral melanoma. When a hyperkeratotic pigmented lesion on the sole is encountered, one should rule out melanoma by careful examination of the periphery of the lesion. Dermoscopy is a helpful adjunct for the diagnosis of an unusual case like this.

Cutaneous Human Papillomavirus Infection: Manifestations and Diagnosis

“…With respect to dermatoscopy this is 'background' pigmentation leaving the doctor mainly dependent on the interpretation of vessels and slightly colored alternative structures (overview given in table 1). These features may help to distinguish viral warts from other diseases such as melanomas [8] but still, the correct diagnosis can sometimes only be revealed by histopathology [9]. Plane warts appear with vessels as dots on structureless yellow to light brown background pigment.…”

Hyperkeratotic Acral Melanoma Mimicking a Common Wart

“…2 , 3 From the clinical point of view, its distinctive feature is to be a great pretender; anything but infrequently, it adopts clinical faces, simulating skin conditions that make the healthcare provider diagnose it as a benign disease of the palms, soles, and ungual regions at first glance. 4 On the other hand, its histological diagnosis is very clear 1 , 3 ; ALM is featured by a marked acanthosis, the presence of a broadened corneum stratum, an elongation of rete ridges, and a lentiginous growth of large tumoral cells along the dermoepidermic junction. The ALM cells also present dendritic processes, atypical and hyperchromatic large nuclei, and often the absence of pigmentation probably due to the great acceleration of the cellular growth that does not allow the correct synthesis of melanin.…”