A black heel...

A 65-year-old man consulted for a non healing ulceration on his right heel.

This ulceration had been occuring on a pigmented lesion present for 5 years. The clinical diagnosis of acral lentiginous melanoma was quite evident on examination.

Melanoma on the palms and soles have a distinct pigment network called parallel ridge pattern. The ridges are centered by white dots which are the openings of eccrine sweat ducts.

In our case, in certain areas parallel ridge pattern had disappeared and was replaced by uniform diffuse brown pigmentation (in which white dots are visible).

An acral lentiginous melanoma has to be differentiated from black heel (or subcorneal hemorrhage) which displays a parallel pattern.

Red lacunes on the ridges

A 28-year old-woman consulted for this dark red acral lesion present since early childhood.

Dermoscopy revealed many red saccules (or lacunes) located on the ridges with a parallel pattern.

This dermoscopic feature was in favor of an hemangioma or an hemolymphangioma

Parallel ridge pattern

A 27-year-old woman consulted for this pigmented lesion on the sole of her left foot present for 2 months. Dermoscopy revealed a parallel ridge pattern and the presence of aggregated black globules, well seen at the border of the lesion (red circle): this unique dermoscopic feature named "pebbles on the ridges" is typical of a subcorneal haemorrhage (or subcorcorneal hematoma, black heel).

Subcorneal hematoma

this 45-year-old patient, bricklayer, consulted for this asymptomatic black lesion on his right heel that he noticed one month ago;the patient did not practice any sports. He used to wear security shoes during his work time. He complained of the hard soles of his shoes.



Dermoscopy (x20) showed a brown light parallel ridge pattern.
The band-like pigmentation is seen on on the ridges of the skin markings. The whitish dots are regularly distributed on the ridges and represent the openings of eccrine ducts.
On the lower site of the lesion, there are many red dots (satellites) allowing to diagnose a subcorneal hematoma or "black heel"
A clue for the diagnosis would be also performing scratching with a blade, because the hematoma is very superficially located .
It is important to remind that the parallel ridge pattern is mainly observed in acrolentiginous melanoma.
The 4 pictures concern the same case of subcorneal hematoma.