An Acral Spot in a 73-Year-Old Male

A 73-year-old male with no significant pathological history, presented in the Dermatology clinic with a melanotic lesion located on the right hallux, with involvement of the nail bed (Fig. 25.1). The lesion had a history of 12 months, with initial location on the distal phalanx and progressive change in size and color. On physical examination, the patient presented an irregular dark-brown pigmented patch, with superficial ulceration located on the distal phalanx of the right hallux (Fig. 25.2), with involvement of the nail, associating nail plate destruction. The patient reported minor bleeding in case of light trauma and no other associated symptoms. There was no evidence of clinically apparent lymph node metastasis. Initially, the patient refused surgical excision and a lesional imprint histology was performed which was not specific, revealing an inflammatory process. After one month, during the follow-up, it was noticed the extent of the pigmentary lesion and the patient underwent a wide local excision of the tumor in the Dermatology department. He was referred to the Oncology Department where it was performed hallux amputation and it was prescribed the therapy designed for his disease stage.