A 18-year-old man consulted for a pigmented lesion on his left heel.

Dermoscopy revealed a parallel ridge pattern and the presence of aggregated black globules, noticeably visible at the border of the lesion : this unique dermoscopic feature named "pebbles on the ridges" is typical of a subcorneal haemorrhage (or subcorcorneal hematoma, black heel).

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.

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).

Pebbles on the ridges

Subcorneal haemorrhage (*) is a differential diagnosis of acral melanoma. This patient who was a squash player consulted for this pigmentation of his anterior right foot. Dermoscopy revealed multiple brown pebble-like droplets on the ridges. This is a unique feature in dermoscopy named "pebbles on the ridges"
Brown sattelites (circled on the picture) were a helpful clue for the diagnosis. Superfical shaving of the corneal layer with a blade confirmed the diagnosis.
* subcorneal hematoma and black heel are synonyms.

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.