Abstract and Introduction
Abstract
Introduction: Due to venous insufficiency, a vascular ulcer frequently occurs with the progression of stasis dermatitis. Achromic melanoma, a rare form of pigmentless melanoma frequently located on the sole of the foot, is often and easily confused with a typical wound. Diagnosis of ulcerated achromic melanoma is thus often delayed and associated with a poor prognosis.
Case Report:The authors report a very rare case of malignant melanoma in a 70-year-old female with stasis dermatitis. The painless ulcer was present for 1 year before the first visit. Upon clinical examination, a 2-cm diameter hypergranulating ulcer with irregular and pigmented borders was present. Dermoscopy revealed the presence of red globules, a gray-to-blue veil, irregular vessels, and the remains of a pigmented ridge pattern. Histological analysis showed infiltration of atypical melanocytes in the dermis, 2 mitoses, and ulceration. Diagnosis of melanoma was confirmed by positive MART-1 immunochemistry. After removal of the melanoma, the area was covered with an autologous skin graft excised from the inner thigh. In accordance with the guidelines, sentinel lymph node biopsy was performed, and the result was negative for lymph node involvement. A comprehensive clinical dermoscopic evaluation led to the correct diagnosis.
Conclusions: The current case highlights the importance of evaluating a chronic, atypical, nonhealing ulcer clinically and dermoscopically as well as through a biopsy procedure.
Introduction
Occurring as a result of chronic venous insufficiency, stasis dermatitis (SD) usually involves the medial part of the lower leg or ankle. Stasis dermatitis is associated with inflammation, edema, and areas that are atrophic, variably pigmented, and scaly. An ulcer is prone to develop with the progression of the stasis and the inflammatory process. In cases of chronic inflammation such as chronic wounds, scars, radiotherapy, burns, osteomyelitis, and fistulas, neoplastic ulcers (Marjolin ulcers) can develop.[1]
Squamous cell carcinoma and basal cell carcinoma are the most frequent subtypes of cancers associated with skin ulcers and SD.[1,2] Lymphomas and other cancers have also been described in skin stasis of the lower limbs.[3] Despite this, such circumstances are uncommon.[1] Achromic melanoma is a rare form of pigmentless melanoma, and it is most frequently located on the sole of the foot. Ulcerated achromic melanoma of the lower limbs can be easily confused with a vascular wound, representing an important dermatological pitfall. Diagnosis is often delayed and is associated with a poor prognosis.[4]
Wounds. 2022;34(2):e10-e12. © 2022 HMP Communications, LLC
