Howard University College of Medicine, Washington, DC, United States.
Howard University College of Medicine, Washington, DC, United States.
J Natl Med Assoc. 2022 Jun;114(3):290-294. doi: 10.1016/j.jnma.2022.01.011. Epub 2022 Feb 25.
Of the four subtypes of cutaneous melanoma, acral lentiginous melanoma (ALM) is atypical in its presentation. ALM is a rare melanoma subtype that presents on the volar surfaces of the hand and foot. The difficulty of making an early diagnosis of ALM is highlighted by the case seen in our institution. The dire prognosis associated with ALM is postulated to be not only related to its destructive nature, but also due to a lack of patient awareness and vigilance, inadequate physician awareness, and disparity in healthcare access. We present this as a unique account of an ALM lesion in a 76 year old African-American male presenting originally in the left foot that went misdiagnosed for several years. The original lesion was considered to be an ulcerating left great toe lesion with signs typical of osteomyelitis. These clinical findings were corroborated by radiological x-ray evidence. Upon amputation and biopsy for suspected worsening osteomyelitis five years later, the pathological diagnosis of melanoma was finally made.
在四种皮肤黑色素瘤亚型中，肢端雀斑样黑色素瘤（ALM）的表现较为特殊。ALM 是一种罕见的黑色素瘤亚型，发生在手和脚的掌侧表面。我们机构所见的病例凸显了早期诊断 ALM 的困难。ALM 预后较差，这不仅与其侵袭性有关，还与患者意识和警惕性不足、医生意识不足以及医疗保健获取的差异有关。我们提出这是一个独特的 76 岁非裔美国男性的 ALM 病变病例，最初发生在左脚，多年来一直误诊。最初的病变被认为是一个溃疡的左大脚趾病变，具有典型的骨髓炎迹象。这些临床发现得到了影像学 X 射线证据的证实。五年后，因疑似骨髓炎恶化而进行截肢和活检，最终做出了黑色素瘤的病理诊断。
