Self-treatment of foot ulcers as a risk factor for delayed diagnosis of acral melanoma.

Dear Editors, We read with interest the article byMansur et al. entitled ‘Acral melanomawith satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry’ (1). We believe that this case will raise awareness and recognition of acral melanomas of the foot in patients with diabetes. In this regard, we would like to contribute to the same topic by presenting another case highlighting a different and interesting cause of the misdiagnosis of acral melanoma. A 67-year-old male patient afflicted with diabetes mellitus (DM) in the last 6 months presented with a non-healing ulcer on the right hallux persisting for almost 2 years (Figure 1). The patient was a physician (gynaecologist) and therefore did not seek professional help but opted tomanage the condition, which he considered a diabetic foot ulcer, by using topical ointments and daily dressing changes. Apart from DM, the patient’s medical history was unremarkable. Given the appearance and the chronicity of the lesion, we referred the patient to the dermatology clinic for a punch biopsy, which revealed a diagnosis of melanoma. The great toe was amputated, and the inguinal lymph nodes were dissected.