Acral melanoma simulating warts: dermoscopic clues to prevent missing a melanoma

Acral melanoma of the heel mimicking a pressure sore

Background

The clinical appearance of acral melanoma is diverse and can cause diagnostic difficulties in individual cases.

Case description

We present a clinical case of an 83-year-old patient with a melanoma in the heel area that was initially interpreted as a pressure ulcer, resulting in delayed and more complicated treatment.

Conclusions

Melanomas should be included in the differential diagnosis even in "typical" pressure ulcer areas. Against the background of increasingly poor healthcare in rural areas, an increase in such cases can be expected.

Dermoscopic Findings in Clinically Diagnosed Cases of Plantar Warts, Corns, and Calluses: A Cross-Sectional Study

INTRODUCTION

 With the naked eye, it can frequently be challenging to tell a plantar wart from a corn or callus. A non-invasive diagnostic method called dermoscopy allows for the inspection of morphological features that are not apparent to the unaided eye. This study aimed to examine the dermoscopic findings in pared and unpared cases of palmoplantar warts, corns, and calluses.

METHODS

Seventy patients who had palmoplantar warts, corns, and calluses were included in this study. A predesigned structured format was used to document the dermoscopic findings.

RESULT

The majority of patients (51.4%) had warts followed by callus (28.6%) and corn (20%). On dermoscopic examination, all unpared and pared cases of warts had homogenous black/red dots. Translucent central core was present in 92.85% unpared and 100% pared lesions of corns. Homogenous opacity was present in 75% unpared and 100% pared cases of callus. There was no association between unpared and pared lesions (p>0.05).

CONCLUSION

The accuracy of identifying various clinical types of cutaneous warts, calluses, and corns can be improved by dermoscopy without paring.

Acral melanoma with hyperkeratosis mimicking a pigmented wart

Acral lentiginous melanoma (ALM) of the sole sometimes has a hyperkeratotic appearance and mimics a pigmented wart. We report a case of an 81-year-old woman with an ALM on the left sole with hyperkeratosis. Due to its presentation it was difficult to make a correct diagnosis at the beginning. Finally we noticed several small, pigmented macules around the wart-like lesion with the parallel ridge pattern on dermoscopy, strongly suggesting acral melanoma. When a hyperkeratotic pigmented lesion on the sole is encountered, one should rule out melanoma by careful examination of the periphery of the lesion. Dermoscopy is a helpful adjunct for the diagnosis of an unusual case like this.

Dermoscopy for the pediatric dermatologist part I: dermoscopy of pediatric infectious and inflammatory skin lesions and hair disorders

The dermoscope allows physicians to examine the macroscopic and microscopic primary morphology of skin lesions, identify subtle clinical clues, confirm naked-eye clinical diagnoses, and monitor treatment progress while posing little threat to the young patient. This review summarizes important dermoscopic structures seen in infectious and inflammatory skin conditions and hair disorders in children. Scabies, pediculosis, phthiriasis, molluscum contagiosum, tinea nigra, and verrucae are well characterized dermoscopically by delta-shaped structures, ovoid-shaped nits, the crab louse, red corona, brown strands or spicules, and multiple densely packed papilla with a central black dot surrounded by a whitish halo, respectively. These dermoscopic structures will be discussed, focusing on the dermoscopic morphologies and dermoscopic sensitivity for diagnosis and its utility in monitoring treatment progress. Dermoscopy has also been shown to significantly improve the clinician's diagnostic and monitoring accuracy of inflammatory skin lesions such as psoriasis, which is characterized dermoscopically by uniformly distributed dotted blood vessels, and lichen planus, which is characterized by whitish lines on a purple to reddish background. Dermoscopy of the hair and scalp (trichoscopy) facilitates the differential diagnosis of hair diseases in children, including alopecia areata, trichotillomania, and tinea capitis. It can also assist in the diagnosis of multiple genetic hair shaft disorders, such as monilethrix, trichorrhexis invaginata, trichorrhexis nodosa, pili torti, and pili annulati.

Dermoscopy as a technique for the early identification of foot melanoma

Malignant melanoma is the most common primary malignant tumour arising on the foot. Where improvements in the prognosis have been observed for patients with melanoma elsewhere on the skin, pedal lesions are still frequently delayed in presentation through neglect or misdiagnosis. Detection of foot melanoma relies on the health care practitioner's skills and observations in recognising early changes. Recent publications have documented the use a dermoscopy as a tool to improve recognition of such suspicious lesions. This paper reviews current literature with a special emphasis of its potential applications on plantar and nail unit melanoma. Data from these studies suggest that the technique is a useful and significant adjunct to clinical examination, which ultimately may lead to earlier recognition of this aggressive tumour.

Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature

Background

Acral lentiginous melanoma (ALM) is an uncommon, cutaneous malignant tumour which may arise on the foot. Its relative rarity, atypical appearance and late presentation frequently serve as poor prognostic indicators.

Methods

At a tertiary skin tumour centre, a retrospective review was undertaken of all patients diagnosed with the tumour at the level of ankle or below.

Results

Over a six year period, 27 cases (20 female, 7 male) were identified with positive histology confirming the disease. The age ranged from 35–96 years of age (mean 62.7 years). The majority of the cohort were white (59%) with plantar lesions (62%). 33% of patients were initially were diagnosed incorrectly. The average time taken from the point of recognition, by the patient, to the lesion being correctly diagnosed was around 13.5 months.

Conclusion

Earlier diagnosis of ALM requires education at both a patient and practitioner level.