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Case Reports
. 2012:2012:502806.
doi: 10.1155/2012/502806. Epub 2012 Apr 4.

A rare form of melanoma masquerading as a diabetic foot ulcer: a case report

Susan Thomas  1 , Yuan-Xiang Meng, Vijaykumar G Patel, Gregory Strayhorn
Affiliations
Case Reports

A rare form of melanoma masquerading as a diabetic foot ulcer: a case report

Susan Thomas et al. Case Rep Endocrinol. 2012.

Abstract

Background. Acral lentiginous melanoma (ALM) is a less-common form of melanoma in US, and it accounts for about 5% of all diagnosed melanomas in US. ALM is often overlooked until it is well advanced because of the lesion's location and its atypical appearance in the early stages. We present a case of ALM initially presented as a diabetic foot ulcer. Case Report. An 81-year-old man initially presented to the primary care clinic with a right foot diabetic ulcer. There was a large plantar, dark-colored ulcer that bled easy. Initial excision biopsy revealed Clark's Level IV ALM. Subsequent definitive wide excision and sentinel node biopsy confirmed ALM with metastasis to inguinal lymph nodes (stage IIIb). The treatment included wide margin excision of the lesion with en bloc amputations of 4th and 5th toes, followed by adjuvant chemotherapy. Discussion. The development of ALM may potentially relate to diabetes as a reported higher prevalence of diabetes with ALM patients. Conclusion. The difficulty in early diagnosing of ALM remains as a formidable challenge particularly in diabetic patients who commonly develop plantar foot ulcers due to the diabetic neuropathy. This case reiterates the importance of a thorough foot exam in such patients.

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Figures

Figure 1
Figure 1
Gross view of the skin lesion on the plantar. The lesion measures 6 × 5 cm with an ulcerated area at the base of fourth and fifth metatarsal involving the interdigital cleft and extending to the forefoot.
Figure 2
Figure 2
Thickened epidermis ulcerated with many heavily pigmented malignant melanocytes (H and E Stains, 40×).
Figure 3
Figure 3
Epidermis and dermis with pigmented malignant melanocytes (H and E stains, 100×).
Figure 4
Figure 4
Atypical tumor cells, some pigmented, some not, with large irregular nuclei with large nucleoli. Spindled and round tumor cells. Heavy cytoplasmic melanin pigment (H and E stains, 400×).
Figure 5
Figure 5
Dermal involvement of tumor cells with uninvolved adjacent deep dermis (H and E stains, 40×).
Figure 6
Figure 6
Right groin sentinel lymph node with heavy tumor cell involvement (H and E stains, 40×).
Figure 7
Figure 7
Tumor cells contrasted with benign lymphocytes of lymph node (Hand E stains, 400×).
See this image and copyright information in PMC

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References

    1. Reed R. Acral lentiginous melanoma. In: Hartmann W, Reed R, editors. New Concepts in Surgical Pathology of the Skin. New York, NY, USA: Wiley; 1976. pp. 89–90.
    1. Hudson DA, Krige JEJ, Stubbings H. Plantar melanoma: results of treatment in three population groups. Surgery. 1998;124(5):877–882. - PubMed
    1. Chen YJ, Wu CY, Chen JT, Shen JL, Chen CC, Wang HC. Clinicopathologic analysis of malignant melanoma in Taiwan. Journal of the American Academy of Dermatology. 1999;41(6):945–949. - PubMed
    1. Luk NM, Ho LC, Choi CL, Wong KH, Yu KH, Yeung WK. Clinicopathological features and prognostic factors of cutaneous melanoma among Hong Kong Chinese. Clinical and Experimental Dermatology. 2004;29(6):600–604. - PubMed
    1. Ishihara K, Saida T, Yamamoto A. Updated statistical data for malignant melanoma in Japan. International Journal of Clinical Oncology. 2001;6(3):109–116. - PubMed

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