Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Authors’ Reply
BRIDGING THE GAP
BRIEF COMMUNICATION
BRIEF REPORT
Case Report
Case Reports
Case Series
CME
CME ARTICLE
CME articles - Practice points
COMMENTARY
CONFERENCE REPORT
CONTROVERSY
Correspondence
Correspondences
CUTANEOUS PATHOLOGY
DRUG REVIEW
E-CHAT
Editorial
EDITORIAL COMMENTARY
ERRATUM
ETHICAL HOTLINE
ETHICS
Field: Evolution of dermatologic surgergy
FOCUS
FROM THE ARCHIVES OF INDIAN JOURNAL OF DERMATO SURGERY
From the Editor's Desk
FROM THE LITERATURE
GUEST EDITORIAL
Guidelines
Images in Clinical Practice
Images in Dermatosurgery
INNOVATION
Innovations
INVITED COMMENTARY
JCAS Symposium
LETTER
Letter to Editor
Letter to the Editor
LETTERS
Message from the President
NEW HORIZON
Original Article
Practice Point
Practice Points
PRESIDENTIAL SPEECH
QUIZ
RESEARCH ARTICLE
Resident’s Page
Review
Review Article
Review Articles
SHORT COMMUNICATION
Spot the Diagnosis [Quiz]
STUDY
SURGICAL PEARL
SYMPOSIUM
Symposium—Lasers
Symposium: Hair in Dermatology
Symposium: Lasers Review Article
View Point
VIEWPOINT
VIEWPOINTS
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Authors’ Reply
BRIDGING THE GAP
BRIEF COMMUNICATION
BRIEF REPORT
Case Report
Case Reports
Case Series
CME
CME ARTICLE
CME articles - Practice points
COMMENTARY
CONFERENCE REPORT
CONTROVERSY
Correspondence
Correspondences
CUTANEOUS PATHOLOGY
DRUG REVIEW
E-CHAT
Editorial
EDITORIAL COMMENTARY
ERRATUM
ETHICAL HOTLINE
ETHICS
Field: Evolution of dermatologic surgergy
FOCUS
FROM THE ARCHIVES OF INDIAN JOURNAL OF DERMATO SURGERY
From the Editor's Desk
FROM THE LITERATURE
GUEST EDITORIAL
Guidelines
Images in Clinical Practice
Images in Dermatosurgery
INNOVATION
Innovations
INVITED COMMENTARY
JCAS Symposium
LETTER
Letter to Editor
Letter to the Editor
LETTERS
Message from the President
NEW HORIZON
Original Article
Practice Point
Practice Points
PRESIDENTIAL SPEECH
QUIZ
RESEARCH ARTICLE
Resident’s Page
Review
Review Article
Review Articles
SHORT COMMUNICATION
Spot the Diagnosis [Quiz]
STUDY
SURGICAL PEARL
SYMPOSIUM
Symposium—Lasers
Symposium: Hair in Dermatology
Symposium: Lasers Review Article
View Point
VIEWPOINT
VIEWPOINTS
View/Download PDF

Translate this page into:

CASE REPORT
5 (
2
); 144-146
doi:
10.4103/0974-2077.99460

Traumatic Hematoma in a Palmoplantar wart Mimicking Acral Lentiginous Melanoma

Plastic and Reconstructive Microvascular Services, Comprehensive Cancer Center, Avinashi Road, Coimbatore, Tamilnadu, India
Department of Pathology, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamilnadu, India

Address for correspondence: Dr. G I Nambi, Plastic and Reconstructive Microvascular Services, Comprehensive Cancer Center, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, Tamilnadu– 641014, India. E-mail: nambi75@rediffmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Abstract

We describe a case where a secondary traumatic hematoma in a pre-existing palmoplantar wart of the sole was presenting a diagnostic dilemma where it simulated an acral lentiginous melanoma and was managed successfully with wide excision and local skin flap.

Keywords

Acral lentiginous melanoma
local skin flap
palmoplantar wart
traumatic hematoma

INTRODUCTION

Palmoplantar wart is a benign skin condition caused by cutaneous human papilloma viruses. Acral lentiginous melanoma is a rare type of melanoma, which is seen most commonly in the palm and plantar aspect of sole. Post-traumatic hematoma that resolves in few weeks is one of the differential diagnostic conditions of melanoma especially when it occurs in the palm and sole. We present an unusual case where an unrecognised traumatic hematoma in a palmoplantar wart was mimicking as acral lentiginous melanoma.

CASE REPORT

A 21-year-old young lady presented with a nodular lesion with glistening surface in the instep region of her right sole since last three months. Except for minimal itch, the lesion was painless and was slow growing. There was a focal area of pigmentation that was seen since last couple of weeks.

On examination, there was an elliptical lesion measuring about 2 × 1.5 cm in the right instep region with focal area of pigmentation in the medial margin [Figure 1]. There were no similar lesions in the proximal part of the limb and there were no regional lymph node involvement. Retrospective enquiries revealed that she had acquired a new foot wear, which was causing repeated irritation of the involved area. This presented a diagnostic dilemma [between a non malignant skin condition and acral lentiginous melanoma] and therefore a decision was made to excise the lesion with a 2 mm margin and do a frozen section biopsy and if positive for melanoma then to get ahead with radical surgery. The lesion was removed surgically [Figures 25] and to our comfort there were no melanotic components and it was found to be a palmoplantar wart with secondary hematoma as it was noted both in frozen section biopsy and in the subsequent final biopsy [Figures 6ad]. The post-excision defect was partly closed primarily and partly with a local flap.

Pre operative image of the lesion with black pigmentation on the inner margin
Figure 1
Pre operative image of the lesion with black pigmentation on the inner margin
Marking for excision with 2 mm margin
Figure 2
Marking for excision with 2 mm margin
Post-excision defect & marking for local transposition flap
Figure 3
Post-excision defect & marking for local transposition flap
Immediate post-op image
Figure 4
Immediate post-op image
Late post-op image
Figure 5
Late post-op image
Subcorneal bulla at the periphery of the lesion with fibrin and haemorrhage (H and E 10×)
Figure 6a
Subcorneal bulla at the periphery of the lesion with fibrin and haemorrhage (H and E 10×)
Pronounced hyperkeratosis with vascular thrombosis and laterally displaced rete (H and E 10×)
Figure 6b
Pronounced hyperkeratosis with vascular thrombosis and laterally displaced rete (H and E 10×)
Abundant eosinophilic keratohyalin and inclusion bodies with perinuclear vacuolisation (H and E 10×)
Figure 6c
Abundant eosinophilic keratohyalin and inclusion bodies with perinuclear vacuolisation (H and E 10×)
Higher magnification of Figure 6C (H and E 40×)
Figure 6d
Higher magnification of Figure 6C (H and E 40×)

DISCUSSION

Acral lentiginous melanoma is a rare type of melanoma that occurs in the extremities in younger individuals. Though diagnosed clinically and later confirmed with investigations, other conditions such as seborrheic keratosis, pigmented actinic keratosis, hemangioma, venous malformation, pigmented basal cell carcinoma and traumatic hematoma can mimic melanomas.[1] Biopsy of the lesion helps in confirming the diagnosis and management.

Palmoplantar warts are benign skin conditions caused by human papilloma viruses, which are also responsible for non-melanoma skin cancers.[2] While smaller warts can be managed by non-surgical methods, larger lesions might require surgical removal. Though the palmoplantar warts may not cause ambiguity in the diagnosis, secondary changes such as traumatic hematoma may cause diagnostic dilemma as seen in this case. We were prudent enough to completely excise the lesion with good margin and then confirm the diagnosis before covering the post-excision defect. Split skin grafts are most commonly used when the defect cannot be closed primarily. In this case, due to the laxity of skin in the instep region, the defect was covered with a local flap so as to give a good colour and contour match.

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES

  1. , , . Plantar melanoma – A false vegetant variant. N Engl J Med. 2006;355:e13.
    [Google Scholar]
  2. , , , , , , . Cutaneous Human Papillomaviruses Persist on Healthy Skin. J Invest Dermatol. 2007;127:116-9.
    [Google Scholar]

Fulltext Views
168

PDF downloads
126
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections