Case ReportRare nodular malignant melanoma of the heel in the Caribbean: A case report

- Malignant melanoma of the heel is a rare melanoma subtype globally.
- This is the first reported case study of malignant melanoma of the heel in the Caribbean.
- Our case highlights the need for the development of strategies to increase patient adherence in developing countries.
- The literature search shows that this is the first reported case of malignant melanoma of the heel among non-fair skin individuals in 40 years.
- Increasing rates of malignant melanoma of the heel suggest the need for increased public awareness, early diagnosis and shared clinical decision making.

IntroductionMalignant melanoma of the heel is a rare melanoma subtype with incidence rates that reflect the complex relationship between sun exposure at certain geographic locations, individual melanin levels and overall melanoma risk. It is oftentimes characterized by poor prognosis because of delays in presentation resulting in longitudinal tumor invasion, lymph node involvement and metastasis.Presentation of caseA 59-year-old woman was admitted to the Eric Williams Medical Sciences Complex, Trinidad and Tobago with a 5 mm pruritic lesion on her left heel. At presentation, the lesion was asymmetric with border irregularities, color heterogeneity, with dynamics in elevation and overall size. She was subsequently diagnosed with malignant melanoma with left inguinal lymphadenopathy. A single stage wide local excision (WLE) of the left heel lesion with a split-thickness skin graft (STSG) and a left inguinal lymphadenectomy were performed. Dacarbazine (Bayer) was administered post operatively.DiscussionGlobally, the incidence of malignant melanoma is rapidly increasing, particularly, in countries like Trinidad and Tobago with a significant population of non-fair skinned individuals. There is need for strategic initiatives to increase patient adherence in these populations.ConclusionThe rarity of malignant heel melanomas heightens the need for increased patient awareness and greater clinical surveillance to ensure early diagnosis and treatment.