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Sonabend ML et al. – A Hispanic man, age 49, reported a three–year history of an enlarging painless ulcer on the plantar surface of his right foot. The ulcer began as a small fleshy bump that had opened and burst several times while continuing to grow. Occasionally, the lesion drained clear liquid, but it never became red, hot, or tender. Other than hypertension, the patient had no past medical history, no surgical history, and no history of trauma to the area. He was not taking any medications. Sensation in his foot was normal...The ulcer was an amelanotic acral melanoma. There are four main melanoma subtypes: superficial spreading (the most common), nodular, lentigo maligna, and acral lentiginous. Excision with margins of 5 mm for in situ melanoma to 2 cm for melanomas at least 2 mm deep is standard. Adjuvant chemotherapy for advanced disease requires referral to an oncologist. On biopsy, this patient's melanoma had a high mitotic rate and Breslow depth close to 4 mm. He was referred first to general surgery for wide excision and sentinel lymph–node biopsy, and then to oncology to be worked up for possible metastatic disease and need for adjuvant chemotherapy.


   

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