Acral melanoma of the hallux

OBJECTIVE: A case of misdiagnosed acral melanoma of the hallux and its diagnostic challenge are herein presented. Acral melanoma is insidious and subtle. A methodic approach to any suspicious lesions is mandatory. A case of misdiagnosed acral melanoma of the hallux is herein reported in a 66-year-old healthy man. Suggestions concerning similar non-healing lesions are herein presented.MATERIALS AND METHODS: It was firstly clinically diagnosed and treated as a micosis at another centre. The absence of any amelioration after three years pushed us to perform a biopsy.RESULTS: An acral melanoma was revealed, treated by amputation.CONCLUSIONS: In case of a non-healing ulcer of the lower extremities, melanoma should be taken into consideration. Even in absence of any suggestive risk factors or clear signs of melanoma, the lack of any improvement after treatment should raise doubts about diagnosis. In particular, biopsy is advisable as a first attempt to guide the management.