Acral melanoma

Acral melanoma of the foot: excision, grafting and wound care

Acral melanoma can resemble a chronic or atypical plantar lesion. Diagnosis and treatment should not be delayed when a lesion changes, ulcerates or fails to heal.

Clinical case

TumourAcral melanoma, thickness over 8 mm, ulcerated

Sentinel nodesTwo positive nodes, no extranodal extension

TreatmentWide excision, free skin graft and VAC for 7 days

Acral melanoma on the sole before surgery — Plantar lesion before oncologic excision.

Defect after wide excision of acral melanoma — Defect after wide excision.

Free skin graft on the plantar excision defect — Free skin graft placed on the defect.

Postoperative healing of a plantar skin graft — Postoperative wound evolution.

Author illustration of acral melanoma treatment planning — Author illustration: wide excision, reconstruction and structured wound care.

What this demonstrates

Plantar excision may leave a defect that cannot be closed directly. A free skin graft can provide coverage, while negative-pressure therapy may help stabilise the graft during the first postoperative days. The pathology and sentinel-node findings guide further multidisciplinary management.

Key point: a persistent atypical lesion on the sole deserves timely clinical assessment and biopsy planning.

Images are de-identified and published with confirmed consent. They are educational and do not replace individual medical advice.

Related resources

Wide local excisionMargins and operative planning Melanoma hubDiagnosis, staging and treatment ConsultationPrepare your records and questions