Abstract

Introduction: Acral lentiginous melanoma is a subtype of melanoma common in Asians with one of the worst prognoses. It is usually detected late especially when situated on the plantar surface of the feet. While other forms of malignancies have been
associated with cutaneous tuberculosis, melanoma is not one of them.

Case Report: PThis is a case of a 78-year-old male with a six-month history of a solitary asymptomatic reddish-brown papule on
the plantar aspect of the right foot, which increased in size evolving into a verrucous plaque. There was no improvement despite
treatment with oral antibiotics and topical antifungals. Dermoscopic findings on different parts of the lesion were suggestive of
both a granulomatous disease and a melanoma. Purified Protein Derivative (PPD) skin test was positive. Histopathologic findings
showed the presence of multinucleated giant cells as well as nests of melanocytes which were highlighted by CD-68 and Melan-A
respectively. With clinicopathologic correlation, diagnosis of the patient was tuberculosis verrucosa cutis and acral lentiginous
melanoma. Complete excision with adequate margins was advised. The patient was started on a 6-month course of anti-Koch’s
medications and was referred to a surgery and oncology for co-management. The patient was subsequently lost to follow up,
until worsening of the lesions 6 months later prompted online consultation, claiming poor compliance to his anti-Koch’s regimen.
Patient was referred to a surgeon who did wide excision biopsy. Histopathologic findings were consistent with acral lentiginous
melanoma. Shortly after the procedure, the patient expired.

Conclusion:This is a rare case of acral lentiginous melanoma and tuberculosis verrucosa cutis existing concomitantly with
each other. This may also be presumed to be the first reported case of acral lentiginous melanoma arising from tuberculosis
verrucosa cutis.

Keywords: Melanoma, Tuberculosis, Dermoscopy