Malignant Melanoma of the Foot

Abstract

A series of 62 cases of malignant melanoma of the foot treated during the period from 1935 to 1967 inclusive is analysed. Melanoma of the foot is twice as common in women as in men, and has highest frequency in the older age groups. The distribution of melanomata of the foot shows the greatest density on the sole of the foot and on the heel. A tendency to spare the weight-hearing areas of the foot, which has so far been thought to be a characteristic feature, was not observed in this series.

The pattern of metastases is discussed. In the vast majority of cases, the metastases first appear in the regional lymph nodes. The lymphatic spread to the skin and subcutis follows a certain pattern. Lymphostasis is a significant factor in the localization of some of these metastases, but is does not explain the pattern formed by the early metastases, occurring in the vicinity of the primary tumour. These metastases presumably spread direct through the intradermal and subdermal lymphatics.

The fully developed melanoma of the foot has a more serious outlook than those involving other regions. The potential causes of this difference is considered. In consequence of the graver prognosis, the treatment consists in excision of the lesion and a large area of the surrounding skin in a sufficient depth without regard being paid to the function of the foot, with primary amputation of the lower leg as an alternative.