Nodular plantar melanoma in a black male and the importance of tumor excision and inguinal lymph node dissection: a case report

Background: Nodular melanoma is a rare and aggressive malignant skin cancer. It is the third most common subtype of melanoma, following acral lentiginous melanoma and superficial spreading melanoma, and accounts for 5–8% of all melanoma subtypes among dark-skinned populations. This manuscript presents a case of nodular melanoma on the plantar surface of the foot with metastasis to the inguinal lymph nodes. Case presentation: An 82-year-old male with no significant medical history was referred by a dermatologist due to recurrent raised skin pigmentation on the plantar surface of the left foot. The lesion was black in color and associated with pain during walking. Wide-margin excision of the melanoma and inguinal lymph node dissection (ILND) were performed. The diagnosis of nodular melanoma was confirmed through clinical examination and histopathological analysis. Clinical discussion: This case highlights the rarity of nodular melanoma among patients of African descent. Its rarity among Africans is likely due to their darker skin and the presence of eumelanin, which filters twice as much ultraviolet radiation as lighter skin. ILND is a crucial strategy, as it can reduce recurrence and improve survival. Conclusion: Nodular melanoma is associated with substantially shorter disease-free survival and a higher case fatality rate compared to other melanoma subtypes. Surgical resection and lymph node dissection are effective in improving prognosis. The possibility of melanoma recurrence must always be considered.