University of Pisa, Pisa, Italy.
Ospedale Civile di Livorno, Livorno, Italy.
Wounds. 2022 Feb;34(2):E10-E12. doi: 10.25270/wnds/2022.e1012.
Due to venous insufficiency, a vascular ulcer frequently occurs with the progression of stasis dermatitis. Achromic melanoma, a rare form of pigmentless melanoma frequently located on the sole of the foot, is often and easily confused with a typical wound. Diagnosis of ulcerated achromic melanoma is thus often delayed and associated with a poor prognosis.
The authors report a very rare case of malignant melanoma in a 70-year-old female with stasis dermatitis. The painless ulcer was present for 1 year before the first visit. Upon clinical examination, a 2-cm diameter hypergranulating ulcer with irregular and pigmented borders was present. Dermoscopy revealed the presence of red globules, a gray-to-blue veil, irregular vessels, and the remains of a pigmented ridge pattern. Histological analysis showed infiltration of atypical melanocytes in the dermis, 2 mitoses, and ulceration. Diagnosis of melanoma was confirmed by positive MART-1 immunochemistry. After removal of the melanoma, the area was covered with an autologous skin graft excised from the inner thigh. In accordance with the guidelines, sentinel lymph node biopsy was performed, and the result was negative for lymph node involvement. A comprehensive clinical dermoscopic evaluation led to the correct diagnosis.
The current case highlights the importance of evaluating a chronic, atypical, nonhealing ulcer clinically and dermoscopically as well as through a biopsy procedure.
由于静脉功能不全，淤滞性皮炎的进展常导致血管性溃疡。无色素性恶性黑素瘤是一种罕见的无色素黑素瘤，常位于足底，常与典型伤口混淆。因此，溃疡性无色素性黑素瘤的诊断常常被延误，且预后不良。
作者报告了一例非常罕见的 70 岁女性淤滞性皮炎合并恶性黑素瘤病例。无痛性溃疡在首次就诊前已存在 1 年。临床检查可见 2cm 直径的高颗粒状溃疡，边缘不规则且色素沉着。皮肤镜检查显示存在红色小球、灰色至蓝色面纱、不规则血管和色素嵴模式的残余。组织学分析显示真皮中浸润性非典型黑素细胞，有 2 个有丝分裂和溃疡。MART-1 免疫化学阳性证实为黑素瘤。切除黑素瘤后，用大腿内侧切除的自体皮片覆盖该区域。根据指南，进行了前哨淋巴结活检，结果为无淋巴结受累。全面的临床皮肤镜评估导致了正确的诊断。
本病例强调了临床和皮肤镜以及活检评估慢性、非典型、不愈合溃疡的重要性。
