Verrucous keratotic melanoma: A misleading form of recurrence

Verrucous keratotic melanoma (VKM) is a rare variant, accounting for approximately 3% of melanomas. Its deceptive clinical presentation, often mimicking benign lesions such as warts or seborrheic keratoses, contributes to frequent misdiagnoses and delayed management. We report the case of an 84-year-old woman with a history of nodular melanoma of the left foot, presenting with recurrent keratotic verrucous lesions at the site of prior surgical excision. Histopathological analysis confirmed VKM with a Breslow thickness of 2 mm and Clark level III. No metastases were detected on positron emission tomography. This case underscores the plasticity of melanoma, which can recur in atypical forms, and highlights the importance of considering VKM in the differential diagnosis of hyperkeratotic lesions. Early recognition and surgical excision are critical to optimizing patient outcomes and reducing the risk of systemic dissemination. Increased awareness of VKM characteristics may improve diagnostic accuracy and management.