(CS-087) Melanoma Disguised as Chronic Ulceration of the Lower Extremity: A Case Series

Alton Johnson, DPM, DABPM, FACPM, FASPS, CWSP – Clinical Assistant Professor, Metabolism, Endocrinology and Diabetes, University of Michigan

Introduction: Melanoma is a malignant tumor arising from the pigment producing cell of the skin (melanocyte). Melanoma of the foot accounts for three to fifteen percent of all cutaneous melanomas. All subtypes are seen, but acral lentiginous melanoma is the most prevalent.

Methods: This case series reports on two patients treated at a large tertiary academic center for acral lentiginous melanoma in March of 2023. Patient 1 was a 60-year-old female with a lesion to the plantar aspect of the right heel. Patient 2 was a 67-year-old male with diabetes and past medical history of melanoma in situ with a non-healing lesion to the plantar right foot.

Results: A punch biopsy obtained from the right plantar heel of patient 1 confirmed the presence of acral lentiginous melanoma with a Breslow depth of 1.8 mm extending to the reticular dermis (Clark level 4). The patient underwent a wide local excision with sentinel node biopsy. This was followed by application of skin substitute and eventual split thickness skin graft. A punch biopsy from the right heel of patient 2 also confirmed acral lentiginous melanoma with a Breslow depth of 3.5 cm extending to the reticular dermis (Clark level 4). As this patient’s disease was recurrent with significant clinical extension, surgical excision was avoided, and the patient pursued medical treatment with oncology.

Discussion:
Clinicians should have a high index of suspicion for malignancy in non healing foot wounds, particularly in the absence of diabetes or vascular disease. There is often a delay in diagnosis of melanomas of the foot as they are commonly attributed to pathologies such as warts, moles or other benign conditions. This in turn leads to rapid disease progression with poor prognosis. This case series demonstrates the importance of obtaining biopsy early on to allow for swift and timely treatment.

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