Acral melanoma with satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry

Abstract

Acral lentiginous melanoma affects the palms, soles, and nail apparatus. Around 3-15% of all cutaneous melanomas are located on the foot and have a poorer prognosis than melanoma elsewhere. Possible reasons for this prognostic difference may be omitting this area during routine skin check by both the patient and the physicians, in addition to misdiagnosis of melanoma as other benign skin lesions. We describe here an elderly female patient treated for a non-healing foot ulcer interpreted as a diabetic ulcer, which after 2 years was diagnosed as acral melanoma with satellitosis. Histopathological examination of the amputated distal phalanx revealed an advanced stage melanoma with 1·2 cm Breslow thickness and of Clark level 5. Dermoscopy of the bluish papulonodules scattered on the dorsal foot showed characteristic findings described for metastasis of skin melanoma. This case underlines the importance of considering skin malignancies in case of chronic, non-healing ulcers in diabetic patients. Furthermore, we point out the critical significance of skin examination as a whole, and dermoscopy being an important tool in the diagnosis of melanoma and/or cutaneous melanoma metastasis.

The Misdiagnosis of Acral Lentiginous Melanoma: Three Case Presentations

“…3 These lesions may also present deficient in pigment (ie, amelanotic variants lacking varying shades of tan/ brown/black), which does not raise as much suspicion as would a deeply pigmented lesion. 5 This is thought to be one factor contributing to the delay in diagnosis and subsequent treatment.…”

Self‐treatment of foot ulcers as a risk factor for delayed diagnosis of acral melanoma

“…Furthermore, failure to diagnose and treat several disorders in time may cause a delay in referrals to expert clinicians and have serious consequences (3). The rate of misdiagnosis of acral melanomas is, indeed, very high (4), and physicians from other specialties, either for themselves or their patient, should consult with a dermatologist about any similar clinical scenarios presented here or in the paper by Mansur et al (1).…”

“…Dear Editors, We read with interest the article by Mansur et al entitled 'Acral melanoma with satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry' (1). We believe that this case will raise awareness and recognition of acral melanomas of the foot in patients with diabetes.…”

Acral melanoma foot lesions. Part 2: clinical presentation, diagnosis, and management

“…AM should always be considered in cases of chronic, nonhealing ulcers. 29 Hence, a thorough foot examination for all patients with diabetes is critical at each clinic visit CMTD CMTD is an inherited neuropathic disease and interestingly, patients with CMTD can also present with multiple primary cutaneous malignant melanomas. This may be due to underlying neural crest abnormalities.…”