Delayed wound healing in acral malignant melanoma: caution for nail extraction without histological evaluation = Delayed wound healing in acral malignant melanoma: caution for nail extraction without histological evaluation

다국어 초록 (Multilingual Abstract)

Acral melanoma is a common subtype of malignant melanoma in Asian population. Because of variable clinicalappearance, the diagnosis could be delayed. A 57-year-old man with diabetes mellitus presented with an unhealed wound on right great toenail after the nail extraction. He noted a pigmented lesion on nail bed 10 years ago, and consistently irritated the lesion so that it became inflamed and the toenail was nearly detached. A partial nail extraction was performed 3 months prior to his visit. He was treated with antibiotics for a week, and biopsy was done on pigmented lesion. Atypical, hyperchromatic, andpleomorphic cellular infiltration were observed in the dermis, and the HMB-45 and MART-1 stain was positive. Based on these findings, he was diagnosed as malignant melanoma and referred to the department of plastic surgery for excision. The PET-CT scan revealed no distant metastasis. Because there were remaining tumor cells in the margin, he was referred to the surgical department for an amputation. The possibility of malignancy is easily overlooked when malignant melanoma is presented with inflammation. Besides, especially when the patient has a deteriorating condition such as diabetes mellitus, histological evaluation is mandatory before an invasiveprocedure. Therefore, we report a case of atypical presentation of acral malignant melanoma, to discuss the necessity of histological approach in a chronic, refractory acral dermatosis.