title: [Post-traumatic acral melanoma: an underestimated reality?].
abstract: BACKGROUND
  The role of trauma in the physiopathology of malignant melanoma remains controversial. We report a case of acral melanoma in which a characterized trauma seems implicated in tumour progression; we performed a review of the literature.
  
  
  METHODS
  A 73-year-old male consulted for a lesion of his right big toe. Physical examination revealed a dystrophic and hyperkeratotic nail destroyed by a growing lesion. Histological study showed an ulcerated superficial spreading melanoma with a Breslow thickness of 4mm. He had previously had this same toe broken, leaving gradually worsening dystrophy of the nail; the toe was injured again spontaneously and by partial removal of the nail tablet.
  
  
  CONCLUSIONS
  A number of cases of "post-traumatic" melanomas have been reported. This hypothesis, though widely admitted for other tumours, remains debated for melanomas mainly because of possible recall bias. In this patient, there was a clear continuum of the lesion as well as topographic correspondence between the initial trauma, the remaining dystrophy and the appearance of the melanoma. Case-control studies have identified trauma as an independent risk factor for acral melanoma with a high relative risk; such risk is multiplied for repeated trauma, suggesting a "dose-effect" relationship. Trauma could act as the promotional stage of melanoma mediated by cytokines released during wound healing or it could cause direct activation of micro-vascular tumour cell transport.
  
  
  CONCLUSIONS
  Our observation and literature research provide convincing arguments for a role of trauma in the development of acral melanomas. Dermatologists must pay attention to any unusual changes in an old scar.
authors.affiliation: Service de dermatologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France. candice.lesage@yahoo.fr
authors.forename: C
authors.initials: C
authors.lastname: Lesage
authors.forename: J
authors.initials: J
authors.lastname: Journet-Tollhupp
authors.forename: P
authors.initials: P
authors.lastname: Bernard
authors.forename: F
authors.initials: F
authors.lastname: Grange
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003937:Diagnosis, Differential; D018409:Foot Injuries / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D050723:Fractures, Bone / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D009260:Nail Diseases / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D009262:Nails / Q000293:injuries* / Q000473:pathology; D017169:Neoplasms, Post-Traumatic / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D012017:Referral and Consultation; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D014034:Toes / Q000293:injuries* / Q000601:surgery