Acral Malignant Melanoma, Extremely Rare Presentation of the Disease

A 30 years old Caucasian male referred to our hand clinic. For more than a year he was treated by his primary care physician and dermatologist for a 5th finger tumor as a common viral wart with no success.

At presentation we found a plamar tumor in the 5th finger of the right hand. The lesion was circle shaped with defined borders, elevated 2 mm above skin level, with papillary surface.

Assuming this lesion was a common wart with failed treatment, we operated on him.The lesion was excised and the rather big palmar wound covered by full thickness skin graft.

Histology diagnosed the tumor as malignant melanoma.Thorough ecologic investigation did not find spread of the disease. Further treatment was by 5th ray amputation,lymph nodes dissection, chemotherapy and radiotherapy.

As of this day the patient is healthy.

We will review the literature and discuss malignant melanoma of the hand with the absolute need for high suspicion rate for lesions which appear to be benign and fail to respond to treatment or behave unexpected.