Non-pigmented nodular plantar melanoma in 12 Japanese patients

In the Japanese, melanoma most commonly involves the plantar surface. Among 61 patients with plantar melanoma, we diagnosed 50 patients as acral lentiginous melanoma (ALM), nine as nodular melanoma, and two as superficial spreading melanoma. Partial or complete loss of pigment was observed in four of the nine nodular melanoma cases and in the nodular portions of eight ALM cases. All 12 such nodular lesions were ulcerated. The clinical diagnosis of malignant melanoma was easily made in the eight patients with ALM by the characteristic pigmentary changes around the nodule. The presence of some remaining pigment was found to be helpful in making the diagnosis in two lesions of nodular melanoma which, at first, had been clinically diagnosed as eccrine poromas. One of two completely amelanotic nodular melanomas was strongly suspected to be a melanoma because there was a history of a pre-existing pigmented macule before the development of the nodule. The other one required histopathological differentiation from Merkel cell carcinoma. Based on these findings and compared with melanoma on other parts of the body, pigmentation noted in the ulcerative nodule of plantar melanoma seems to disappear easily. This causes difficulty in distinguishing it from other skin tumours.