Acral Hypomelanocytic Melanoma of Left Great Toe: A Rare Cancer

The Malignant melanoma is an uncommon primary malignant tumour of the foot.1 It occurs in different forms like superficial spreading, nodular, lentiginous and acral. Amelanotic/ hypomelanotic melanoma is a non-pigmented variety of cutaneous melanoma accounting for 2-8% of all primary melanomas.2,3 The lesion is usually exophytic and ulcerative with or without metastasis. The lesions usually begin in subungal location of toe and because of absence of pigment, the lesion is often misdiagnosed. Hence diagnosis by histopathological examination and metastatic work up is necessary.2,3 We highlight a case of primary amelanotic melanoma of the left great toe treated by digital amputation. A 65-year-old male presented with a 10 month old painful ulcero-proliferative growth on the great toe of the left foot. The small nodular lesion was started on plantar aspect of the toe and progressed to the size of 4x5 cm with development of ulceration and irregular margins over the period of 3 months (Figure 1). On clinical examination no lymphadenopathy was palpable. The digital amputation of left great toe with 1 cm margin clearance (Figure 2) was done and specimen sent for histopathological examination. Histopathological microphotograph (Figure 3) shows nodular aggregates of course pigmented malignant cells extending deeply within the dermis with abnormal mitosis suggestive of malignant melanoma.