Intracorneal Hematoma Showing Clinical and Dermoscopic Features of Acral Lentiginous Melanoma

Abstract

Intra- and subcorneal hematoma, a skin alteration seen palmar and plantar after trauma or physical exercise, can be challenging to distinguish from in situ or invasive acral lentiginous melanoma. Thus, careful examination including dermoscopic and histologic assessment may be necessary to make the correct diagnosis. We here present a case of a 67-year-old healthy female patient who presented with a pigmented plantar skin alteration. Differential diagnoses included benign skin lesions, for example, hematoma or melanocytic nevus, and also acral lentiginous melanoma or melanoma in situ. Since clinical and dermoscopic examinations did not rule out a malignant skin lesion, surgical excision was performed and confirmed an intracorneal hematoma. In summary, without adequate physical trigger, it may be clinically and dermoscopically challenging to make the correct diagnosis in pigmented palmar and plantar skin alterations. Thus, biopsy or surgical excision of the skin alteration may be necessary to rule out melanoma.

Subcorneal hematoma as an imitator of acral melanoma: Dermoscopic diagnosis

“…They stated that the presence of reddish and grayish coloration can be clues to SH in such cases. Parallel ridge pattern has also been revealed in two different case reports of SH [2,10]. We hypothesized that parallel ridge pattern observed in SH, may be associated with a particular arrangement of dermal vascular plexus beneath the crista superficialis.…”

“…SH describes a traumatic rupture of the dermal papillary capillaries resulting extravasation of red blood cells into stratum corneum of the skin [1]. Many other terms, including intracorneal hematoma [2], talon nair [3], black heel [4], basketball heel [5], hyperkeratosis hemorrhagica [6] and tennisferse [7], have been used to define this condition. It is not always easy to diagnose SH correctly by unaided eye.…”

“…It is not always easy to diagnose SH correctly by unaided eye. Acral melanoma is the main differential diagnosis of the entity [1,2]. Acral nevi, pyogenic granuloma, angiokeratoma and even plantar warts should also be in the differential diagnosis list [1].…”

Talon Noir: A Case Report and Literature Review

“…A few cases were also observed involving extremities of age with no such typical histories. An unusual case of a viral infection-associated black heel has also been reported [4,6,7].…”

“…Acral melanoma, on the contrary, shows a typical parallel ridge pattern with irregular pigmentation. Because some studies have claimed that dermoscopic features may be misleading, scraping test and biopsy are the preferred methods to differentiate between these two conditions, especially long-standing cases with dubious findings [4,7,8]. Scraping or paring down of talon noir leads to partial or complete loss of pigmentation, whereas melanocytic lesions remain the same [9,11,12].…”