Advanced acral melanoma.

CASE REPORT A 47-year-old Caucasian man presented to the dermatology department for evaluation of a mass on his left foot. Six years prior, the patient had dropped a sledgehammer on his left great toe causing significant toenail damage, nail loss, and enlarging ulceration despite meticulous wound care. Ten months before presentation, the patient noted rapid growth of the left great toe mass that began to encompass the majority of the distal aspect of his foot. As the mass grew, the patient reported foul-smelling discharge, tissue sloughing, and bleeding. Three months before presentation, a mass appeared in the patient’s left groin, along with scattered firm nodules on the left calf and thigh. The patient had not sought medical care for the mass other than 1 visit to the emergency department 2 months prior, during which the patient declined oncology consultation. He attributed his reluctance to seek medical care to lack of insurance and his belief that the growth was caused by an infection. On examination, the patient had a 303 17-cm fungating, irregularly shaped necrotic mass engulfing his great toe and the majority of the distal medial aspect of his foot (Fig 1). There were multiple violaceous subcutaneous nodules along the thigh and a 15-cm firm, bound-down mass in the left groin