title: Rare nodular malignant melanoma of the heel in the Caribbean: A case report.
abstract: BACKGROUND
  Malignant melanoma of the heel is a rare melanoma subtype with incidence rates that reflect the complex relationship between sun exposure at certain geographic locations, individual melanin levels and overall melanoma risk. It is oftentimes characterized by poor prognosis because of delays in presentation resulting in longitudinal tumor invasion, lymph node involvement and metastasis.
  
  
  METHODS
  A 59-year-old woman was admitted to the Eric Williams Medical Sciences Complex, Trinidad and Tobago with a 5mm pruritic lesion on her left heel. At presentation, the lesion was asymmetric with border irregularities, color heterogeneity, with dynamics in elevation and overall size. She was subsequently diagnosed with malignant melanoma with left inguinal lymphadenopathy. A single stage wide local excision (WLE) of the left heel lesion with a split-thickness skin graft (STSG) and a left inguinal lymphadenectomy were performed. Dacarbazine (Bayer) was administered post operatively.
  
  
  CONCLUSIONS
  Globally, the incidence of malignant melanoma is rapidly increasing, particularly, in countries like Trinidad and Tobago with a significant population of non-fair skinned individuals. There is need for strategic initiatives to increase patient adherence in these populations.
  
  
  CONCLUSIONS
  The rarity of malignant heel melanomas heightens the need for increased patient awareness and greater clinical surveillance to ensure early diagnosis and treatment.
authors.affiliation: Division of Oncology, Siteman Cancer Center, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address: wayne.warner@wustl.edu.
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Warner
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: vandanahealth@gmail.com.
authors.forename: Vandana Devika
authors.initials: VD
authors.lastname: Sookdeo
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: srikanth.umakanthan@sta.uwi.edu.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Umakanthan
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: kevinsarran1@yahoo.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sarran
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: pran1919@icloud.com.
authors.forename: Lemuel
authors.initials: L
authors.lastname: Pran
authors.affiliation: Department of Radiology, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: mfortune333@hotmail.com.
authors.forename: Maurice
authors.initials: M
authors.lastname: Fortuné
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: wesgreavesmd@gmail.com.
authors.forename: Wesley
authors.initials: W
authors.lastname: Greaves
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: skinnovationstt@gmail.com.
authors.forename: Sharda
authors.initials: S
authors.lastname: Narinesingh
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: dave_harnanan@yahoo.com.
authors.forename: Dave
authors.initials: D
authors.lastname: Harnanan
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: drravimaharajuwi@gmail.com.
authors.forename: Ravi
authors.initials: R
authors.lastname: Maharaj
keywords: Caribbean; Left inguinal lymphadenectomy; Malignant melanoma; Skin