A Bleeding Toe
A 52-year-old man presented to the outpatient clinic with a bleeding mass on his right great toe. Two months earlier, the patient had noticed a pink nodule that was approximately 5 mm in diameter on the dorsum of the toe. One month later, his toe was stepped on, after which the nodule grew rapidly and bled intermittently. On examination, the lesion was red and ulcerated with surrounding hyperpigmentation (Panel A). He was referred for surgical resection. During surgery, brown–black patches were found on the bottom of the mass. Histologic analysis of both the resected mass and the patch underneath it showed nests of melanoma cells (Panel B). A diagnosis of acral lentiginous melanoma, with a Breslow depth of 2.5 mm and Clark level IV (indicating invasion of the reticular dermis), was made. Extended resection of the lesion and skin grafting were performed. The result of sentinel-lymph-node biopsy was negative. The patient received treatment with interferon alfa-2b after surgery. At the 18-month follow-up, there was no evidence of recurrence or metastasis.