Mrs. Smith,
Yes, we do remember you and we're delighted to hear that your wound has healed! Now, with the summer months approaching you'll be able to return to your gardening, walking and trips to the shore. But before you begin basking in the sunshine of another summer, Mrs. Smith, keep in mind that the sun may, in some instances, lead to the development of various forms of pedal skin cancer, some of which may be deadly. In addition, though most skin cancers arise as the result of persistent sun exposure, this is not necessarily true when such tumors arise on the skin of the foot. Rather, in addition to the sun, pedal skin cancers may also arise as the result of oncogenic viruses, exposure to chemical carcinogens, chronic inflammation, or simply genetic predisposition.
Cancers of the skin of the feet have several features in common, for instance, most are painless, and in many instances, they elicit a history of recurrent cracking, bleeding, or ulceration. In addition, it is not uncommon for the affected person to discover their lesion as the result of unrelated trauma near the affected site. Some of the most common cancers of the lower extremity are squamous cell carcinoma, basal cell carcinoma, and one of the most deadly cancers known to man, malignant melanoma.
It's estimated that over 70,000 new cases of melanoma will be diagnosed in 2010, with estimates of 9,000 deaths due to this disease. Melanomas are not uncommon on the skin of the feet, in fact, at Bako Pathology Services, where we receive tissue samples from podiatrists from across the U.S., our dermatopathologists make the diagnosis of melanoma over 10 times per week. Though this form of cancer may be deadly, it is important to remember that melanoma can be cured if detected and treated early. One of my favorite songs is "One Love" by Bob Marley, which always reminds me of the importance of early detection. Bob Marley was only 36 when he died of malignant melanoma which began in his right great toe. Lengthy delays prior to the diagnosis and management of his cancer probably cost him his life.
Mrs. Smith, malignant melanoma has a wide array of potential clinical appearances, leading to its nickname "The Great Masquerader". Here's what to look for: 1) Asymmetry-one side of a lesion is not a mirror image of the other. It may look like a mole with tan-brown or black pigment, or in 1/3 of cases it will lack brown pigment and appear pink-red. 2) An irregular border- the edge of lesion may be scalloped. It may be level with the surrounding skin surface or, in time, it may become elevated. 3) Color- there may be a range of colors within a single lesion, with tans, black, red, blue, etc. 4) Large diameter- most will have a diameter of over 6mm. Melanomas may resemble benign moles, blood blisters, plantar warts, ischemic ulcers, foreign bodies, or bruises.
Podiatrists are uniquely trained to recognize and treat conditions as they present themselves on the skin of the feet. Because melanoma may have a very different appearance when it arises on the foot, this expertise is of extreme importance for detecting malignancies in a timely fashion. Your podiatrist will investigate the possibility of melanoma, and other skin cancers, with the use of a skin biopsy. This is a simple procedure whereby your podiatrist will obtain a small sample of the lesion in question and send it to a skin pathologist for analysis. To ensure that you receive the very best in care, your podiatrist will likely require that your biopsy be sent to a lab with board-certified dermatopathologists who have expertise in the analysis of lesions from the skin of the foot.
Mrs. Smith, remember, if caught early melanoma and other cancers of the skin are entirely curable. If you should see anything on your skin that seems unusual, please make sure to see a medical expert as soon as possible. Enjoy your summer, Mrs. Smith! We're here to help so please let us know if you have any questions.
Your friends at Bako Pathology Services 
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