“The Malignant Wart”: A Review of Primary Nodular Melanoma of the Foot and Report of Two Cases

The reported incidence of melanoma is rapidly rising and second only to lung cancer. Primary melanoma of the lower extremity accounts for approximately 30% of all cases reported, with half of these cases localized to the foot itself. Unfortunately, melanoma can be misdiagnosed and treatment delayed, as they are usually not painful. The overall 5- and 10-year survival rates improve with early diagnosis and aggressive treatment. This is a report of 2 cases of primary nodular melanoma of the foot initially misdiagnosed as a “wart.” Following confirmation with biopsy, definitive surgical intervention in both cases consisted of resection of the primary malignancy and ipsilateral superficial inguinal lymph node basin resection using a multidisciplinary approach to patient care. Given the rapid increase in incidence of melanoma in the general population, one must have a high index of suspicion and low threshold for excisional biopsy of concerning dermatopathology on the foot and lower extremity. Early detection and combined appropriate surgical resection and adjunctive chemotherapeutic treatment of melanoma in a multidisciplinary setting are paramount in decreasing mortality rates.