Primary cutaneous melanoma of the foot

A 97 years old lady was admitted through the clinic with the history of a painless black lesion in the sole of her left foot. She clearly remembered presence of a nevus at that site since her childhood. The lesion had started to increase in size over the last two years and as it was not painful with no discharge or itching, she decided to delay medical consultation. She had associated osteoarthritis in both knees and angina pectoris, which was well-controlled on medications. Local examination revealed a 2 cm pigmented lesion with an irregular raised surface and irregular margins in the sole of the left forefoot. No intransit lesion could be visualized and the ipsilateral inguinal lymph node were not palpable. Systemic examination did not reveal any evidence of distant metastasis. The patient underwent routine preoperative blood tests including CBC, blood sugar level, renal function profile and ECG which were all essentially normal. The radiological metastatic workup was negative for systemic disease. She underwent excision biopsy under general anaesthesia which on frozen section confirmed malignant melanoma. A wide local lesion with 1.5 cm clearance and excision upto the plantar fascia was done. A split skin graft was placed to facilitate wound closure. Her post operative course was unremarkable and she was discharged next day from hospital. The final histopathology confirmed malignant melanoma Clark level 5 with clear margins of resection