A non‐healing ulcer: amelanotic melanoma

A 73‐year‐old woman presented with a 7‐month history of a non‐healing ulcer on her left hallux (Figure), having seen multiple medical professionals previously. She had no history of diabetes, peripheral vascular disease, or neuropathy. Biopsy demonstrated an amelanotic melanoma with a Breslow thickness of 4 mm and tumour mitotic rate of 1/mm². No evidence of metastasis was evident on imaging, categorising her disease as stage IIC (T4bN0M0). She proceeded to amputation at the interphalangeal joint and continues lifelong clinical and radiological surveillance. This case demonstrates the importance of skin biopsy for any non‐healing ulcers. Differential diagnoses include neoplastic, infectious, vasculopathic, autoinflammatory and haematological aetiologies.1 Biopsy is recommended for ulcers with an atypical clinical presentation, recalcitrant to standard care and those with dynamic change over a period greater than one month.2,3