BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2122 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2122
  1. R Seys Llewellyn, core medical trainee 2 ,
  2. F Joseph, consultant physician ,
  3. D Ewins, consultant physician ,
  4. N Goenka, consultant physician ,
  5. E Domanne, consultant physician ,
  6. A Franks, consultant physician
  1. 1Countess of Chester Hospital, Chester CH2 1UL, UK
  1. rllewellyn@doctors.net.uk

A 76 year old woman who regularly attended the diabetes clinic presented with an 18 month history of this pigmented ulcerated lesion on her right hallux, initially treated as a necrotic neuropathic ulcer. Suspicion was raised when nail removal to expedite healing resulted in extensive bleeding, warranting an urgent referral to dermatology. Incisional biopsy showed an acral lentiginous malignant melanoma of Breslow thickness 2.1 mm and Clarke level four. Wide local excision in the form of amputation and sentinel node biopsy was performed. Clinicians dealing with patients with diabetes should be aware of possible melanomas masquerading as poorly healing, necrotic neuropathic ulcers.


Cite this as: BMJ 2012;344:e2122


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