A Case of Amelanotic Melanoma Arising in Hyperkeratotic Lesions of the Heel

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  • Yamada Hanae
    Department of Dermatology, The Jikei University School of Medicine
  • Soma Takamitsu
    Department of Dermatology, The Jikei University School of Medicine
  • Shimada Nanako
    Department of Dermatology, The Jikei University School of Medicine
  • Yoshida Hisatoshi
    Department of Dermatology, The Jikei University School of Medicine
  • Ito Hideki
    Department of Dermatology, The Jikei University School of Medicine
  • Koda Masato
    Department of Dermatology, The Jikei University School of Medicine
  • Matsuo Koma
    Department of Dermatology, The Jikei University School of Medicine
  • Isiji Takaoki
    Department of Dermatology, The Jikei University School of Medicine
  • Nakagawa Hidemi
    Department of Dermatology, The Jikei University School of Medicine

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Other Title
  • 踵部の過角化病変上に生じた無色素性悪性黒色腫の1例―掌蹠角化症に生じた悪性黒色腫の検討―
  • ショウブ ノ カカクカ ビョウヘン ジョウ ニ ショウジタ ムシキソセイ アクセイ コクショクシュ ノ 1レイ ショウセキカッカショウ ニ ショウジタ アクセイ コクショク シュ ノ ケントウ

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Abstract

A 59-year-old male had amelanotic melanoma arising in hyperkeratotic lesions of the heel which had been present since childhood. He sometimes shaved them. There were no such lesions on his palms. The same lesions were recognized in his mother, brother and two of his children. Based on the positive family history and clinical manifestations, the hyperkeratosis is strongly suspected to be hereditary plantar keratoderma. He had noticed erosions and a red granulomatous tumor on his right heel year before the first visit to our hospital. A biopsy specimen obtained from the tumor histologically revealed malignant melanoma. Subsequently, the tumor was surgically removed completely with a 30 mm margin. Sentinel lymph node biopsy revealed positive nodes in the inguinal and popliteal areas; 15 inguinal lymph nodes and 2 popliteal lymph nodes were dissected, and 3 inguinal lymph node and 2 popliteal lymph node metastases were found, leading to the diagnosis of stage IIIC (pT4bN3M0). After the operation, five courses of DAV-Feron chemotherapy were followed by continuous local Feron injection twice a month. One and a half years later, right external iliac lymph node metastasis was found. and the intrapelvic lymph nodes were dissected. Two years after the operation, multiple lung and liver metastases were evident, and he died of liver failure. The association of malignant melanoma with hereditary palmoplantar keratoderma is relatively rare. Chronic mechanical irritation may have affected the onset of malignant melanoma of hereditary plantar keratoderma in this case.

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