Traumatic Hematoma in a Palmoplantar wart Mimicking Acral Lentiginous Melanoma

Abstract

We describe a case where a secondary traumatic hematoma in a pre-existing palmoplantar wart of the sole was presenting a diagnostic dilemma where it simulated an acral lentiginous melanoma and was managed successfully with wide excision and local skin flap.

Keywords: Acral lentiginous melanoma; local skin flap; palmoplantar wart; traumatic hematoma.

Figure 1

Pre operative image of the lesion with black pigmentation on the inner margin

Figure 2

Marking for excision with 2 mm margin

Figure 3

Post-excision defect & marking for local transposition flap

Figure 4

Immediate post-op image

Figure 5

Late post-op image

Figure 6a

Subcorneal bulla at the periphery of the lesion with fibrin and haemorrhage (H and E 10×)

Figure 6b

Pronounced hyperkeratosis with vascular thrombosis and laterally displaced rete (H and E 10×)

Figure 6c

Abundant eosinophilic keratohyalin and inclusion bodies with perinuclear vacuolisation (H and E 10×)

Figure 6d

Higher magnification of Figure 6C (H and E 40×)