Abstract
Malignant melanoma is the most common primary malignant tumour arising on the foot. Where improvements in the prognosis have been observed for patients with melanoma elsewhere on the skin, pedal lesions are still frequently delayed in presentation through neglect or misdiagnosis. Detection of foot melanoma relies on the health care practitioner's skills and observations in recognising early changes. Recent publications have documented the use a dermoscopy as a tool to improve recognition of such suspicious lesions. This paper reviews current literature with a special emphasis of its potential applications on plantar and nail unit melanoma. Data from these studies suggest that the technique is a useful and significant adjunct to clinical examination, which ultimately may lead to earlier recognition of this aggressive tumour.
Highlights
Cancers involving the skin account for a third of all human cancers
The dermatoscope has been found useful for the examination of the skin, but the foot has offered a particular challenge to the technique, firstly, because of its thickened acral plantar surface which gives an altered presentation of pigmentation [40] and secondly the nail unit which frequently presents with pigmentation due to a range of causes including haematoma and melanoma
Current evidence still demonstrates a rise in the incidence of melanoma, the most lethal form of skin cancer
Summary
Cancers involving the skin account for a third of all human cancers. According to the World Health Organisation, malignant melanoma (MM) accounts for an estimated 132 000 new cases annually and around 66 000 deaths. The use of the dermatoscope was initially the exclusive realm of the dermatologist, experimental and early work gave rise to extensive descriptions of patterns and features visualised in melanocytic naevi, melanoma and other skin tumours This moved to the formalisation of the technique into various algorithms such as pattern analysis [30], the 7-point technique [31], the modified ABCD technique [32] and the Menzies method [33]. The dermatoscope has been found useful for the examination of the skin, but the foot has offered a particular challenge to the technique, firstly, because of its thickened acral plantar surface which gives an altered presentation of pigmentation [40] and secondly the nail unit which frequently presents with pigmentation due to a range of causes including haematoma and melanoma. Myazaki and colleagues identified 3 specific pigment patterns determined as normal in benign melanocytic naevi of plantar skin parallel furrow, lattice-like and fibrillar pattern [4144] (figure 4). Neither of these have been formally tested to identify their true validity but with time one would expect further development in this area as experience increases
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