Acral amelanotic melanoma mimicking common dermatologic conditions

Amelanotic melanoma is an uncommon and diagnostically challenging subtype of malignant melanoma. Lesions in acral locations, such as the soles, may mimic benign conditions, leading to delayed diagnosis and poor prognosis. Early biopsy of atypical, non-healing plantar lesions is critical. This study reports the case of a 59-year-old male who presented with disseminated cutaneous nodules and systemic symptoms. The largest primary lesion was a pink, fibrin-covered nodule on the left heel with satellite papules. Imaging revealed nodal, pulmonary, and cerebral metastases. Histopathology of plantar and shoulder lesions confirmed acral nodular amelanotic melanoma with dissemination. Initial medical contact was delayed by limited healthcare access and the lesion’s atypical, non-pigmented appearance. The patient received ipilimumab-nivolumab and stereotactic radiotherapy, then dacarbazine and subsequently carboplatin-paclitaxel for progression, consistent with contemporary guideline pathways for unresectable stage III/IV disease. Despite therapy, the patient died within a year of first presentation. Acral amelanotic melanoma may masquerade as ulcers, calluses, warts, or traumatic lesions. Non-healing, atypical plantar lesions warrant prompt biopsy. Practical screening aids ( e.g. , CUBED) can trigger early referral, but clinical suspicion and biopsy remain decisive.