Amelanotic melanoma presenting as a pyogenic granuloma

A sixty-two year old man was diagnosed as having an amelanotic of the right great toe after the lesion had been treated for several months as a pyogenic granuloma. Establishment of the correct diagnosis was aided by the finding of a radiolucent defect on a roentgenogram of the toe. Since amelanotic melanoma usually presents as a vascular or ulcerated nodule, rather than as a pigmented nevus, the lesion may be mistaken for a benign tumor. This case illustrates the necessity of histologic confirmation of all presumed pyogenic granulomas. Furthermore, it also stresses that clinical, histologic, and prognostic distinctions must be made between amelanotic melanoma and its pigmented counterpart.