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SPOT THE DIAGNOSIS
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 68-69

Brownish black nodule over foot − a subtle presentation of a grave disorder


Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission12-Jul-2019
Date of Decision21-Sep-2020
Date of Acceptance02-Nov-2020
Date of Web Publication07-Apr-2021

Correspondence Address:
Dr. Muthu Sendhil Kumaran
Additional Professor, Department of Dermatology, Venereology and Leprology, PGIMER Chandigarh 160012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/Pigmentinternational.Pigmentinternational_

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Keywords: Dermoscopy, histopathology, melanoma


How to cite this article:
Manjunath S, Bishnoi A, Kumaran MS. Brownish black nodule over foot − a subtle presentation of a grave disorder. Pigment Int 2021;8:68-9

How to cite this URL:
Manjunath S, Bishnoi A, Kumaran MS. Brownish black nodule over foot − a subtle presentation of a grave disorder. Pigment Int [serial online] 2021 [cited 2021 Aug 2];8:68-9. Available from: https://www.pigmentinternational.com/text.asp?2021/8/1/68/313132



A 58-year-old male presented with 1-year history of blackish asymptomatic nodule on right sole, which initially started as pinhead-sized papule and progressed to the present size. There was no previous history of bleeding or oozing from lesion. Patient denied history of trauma or a prior melanocytic nevus. Clinical examination revealed well-defined, irregular, brownish black, infiltrated noduloplaque measuring 6 × 7 cm over right heel [Figure 1]. There was no lymphadenopathy. Dermoscopy of lesion revealed multiple colors (dark brown, blue, gray, and black), irregular brown and black dots, and globules [Figure 2].
Figure 1 Brownish black pigmented infiltrated noduloplaque with irregular border over right heel

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Figure 2 Dermoscopy showing multiple colors (ranging from tan, dark brown, blue, gray, and black), irregular blotches, irregular brown dots and globules, and black colored areas

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What is the diagnosis?

Melanoma is a malignant tumor arising from melanocytes. It is classified into four types based on histopathology, namely, superficial spreading type, acral lentiginous type, nodular type, and lentigo maligna melanoma.[1] Melanoma in Indians is rare compared to Caucasians with age-specific incidence less than 0.5 per 1,000,000. Nodular melanomas are rapidly proliferating tumors presenting in older individuals as firm papules or nodules with frequent ulceration. Those arising from nail unit or sole often present late, contributing to diagnostic delay and hence poor outcome.[2] Dermoscopy of pigmented nodular melanoma visualizes a symmetrical pattern of pigmentation with blue, black, tan, and milky red or pink areas, multiple blue-gray dots, blue white veil, scar-like depigmentation, irregularly distributed and sized brown dots and globules, atypical broadened network, large diameter vessels, and predominant peripheral vessels. Histopathology shows dermal mass of dysplastic tumor cells which are round and epithelioid in morphology with hyperchromatic nuclei invading into epidermis [Figure 3]. Considering the size and location, our patient was referred to surgery for further management. Even though dermoscopy does not obviate the need for biopsy, it is a powerful tool helping to diagnose melanoma early even before specific histopathological findings develop and helps in ruling out other pigmented lesions such as benign melanocytic nevi and Kaposi sarcoma.[3]
Figure 3 Epidermis shows parakeratosis and a tumor is seen arising from the basal layer and extending into the dermis. Individual tumor cells are moderately to markedly pleomorphic and have round nuclei with coarse chromatin and prominent eosinophilic large nucleoli. Melanin pigment is seen in some of the tumor cells (hematoxylin and eosin 100×)

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bishop JN, Bataille V, Gavin A, Lens M, Marsden J, Mathews T, Wheelhouse C. The prevention, diagnosis, referral and management of melanoma of the skin: concise guidelines. Clin Med (Lond) 2007;7:283-90.  Back to cited text no. 1
    
2.
Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res 2010;3:25.  Back to cited text no. 2
    
3.
Menzies SW, Moloney FJ, Byth K et al. Dermoscopic evaluation of nodular melanoma. JAMA Dermatol 2013;149:699-709.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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