Another Case of Interdigital Located "Metastasing Hematoma"?

Abstract

Interdigital spaces could be an area of affection of a various cutaneous conditions, most of them with benign origin. The spectrum of differential diagnosis of pigmented interdigital lesions with a recent occurrence is not so wide, in contrast. When considering pigmented lesions in the interdigital area, the most harmless differential diagnosis is a traumatic hematoma. But what would happen if we based our therapeutic behaviour or suspicious and unconfirmed harmless diagnosis, instead of considering the real life-threatening once with priority, if we kept in mind that acral lentiginous melanoma has rather an aggressive course and is the main cause of death in skin cancer patients? We present a case of misdiagnosed interdigital melanoma, treated as a hemangioma with curettage, with almost fatal consequences, in regard to uncontrolled tumor progression as a result of the wrong traumatic procedure in one hand, and the lack of adequate screening and follow up, leading to progress of the disease with lymph node metastasis and poor prognosis in general. We want to emphasise the importance of acral lentiginous melanoma with an unusual location in the differential diagnostic plan because, despite the early detection, early eradication with simple excision could save a life, or at least could provide a better prognosis.

Keywords: Dermatoscopy; Hematoma; Melanoma; Misdiagnosis; Sentinel lymph node.

Figure 1

a – Clinical manifestation of interdigital acral lentiginous melanoma, four months after curettage for hematoma; b, c – Intraoperative findings. Surgical excision of the interdigital melanoma, under local anaesthesia; d, e, f – Intraoperative findings of the lymph node dissection. Dark coloured packages of enlarged lymph nodes with a firm texture, measuring 2,5 cm were established intraoperatively. Enlarged lymph nodes were observed in the obturator whole, with the same characteristic. A lymph node was found in the pelvis immediately adjacent to the v. iliaca external, infiltrated the vein wall. A partial resection of the vein was performed, as the same was reconstructed with a single stitch