Melanoma and Skin Cancer of the Foot: Recognition, Risk

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Malignant melanoma of the foot — including subungual melanoma affecting the toenail unit — is among the most important diagnoses not to miss in podiatric practice. Foot melanoma carries a significantly worse prognosis than melanoma at other sites because of diagnostic delay: the foot is a low-visibility body location that patients rarely systematically examine, and foot melanoma is frequently misdiagnosed as plantar wart, fungal infection, subungual hematoma, or benign nevus by non-dermatologic providers. Early recognition and prompt referral are life-saving.

Acral Lentiginous Melanoma

Acral lentiginous melanoma (ALM) — the subtype of melanoma occurring on the palms, soles, and subungual locations — is the most common melanoma subtype in patients with darker skin (African American, Asian, and Hispanic patients) and accounts for 5–10% of all melanomas. ALM does not arise from sun-damaged skin — UV exposure is not the primary risk factor — making primary prevention messaging about sun protection irrelevant for this subtype. The typical ALM presentation is a pigmented plantar lesion with irregular borders and color variation (tan, brown, black, with possible pink or amelanotic areas). The classic misdiagnosis is plantar wart or callus; any pigmented plantar lesion with the ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution) requires dermatologic biopsy referral.

Subungual Melanoma

Subungual melanoma presents as longitudinal melanonychia (a dark pigmented streak running the length of the nail) that broadens, darkens, or develops Hutchinson’s sign (pigmentation extending into the proximal nail fold or periungual skin). The key distinction from benign longitudinal melanonychia (common in darker-skinned individuals) is Hutchinson’s sign, progression, and irregular pigment distribution. Any new or changing longitudinal melanonychia, particularly in patients over 50, warrants dermatology referral for nail matrix biopsy. Subungual hematoma — the most common mimic — can be distinguished by history of trauma and progressive growth of the distal nail margin as the hematoma moves distally with nail growth.

Other Foot Skin Cancers

Squamous cell carcinoma (SCC) of the plantar foot can present as a non-healing ulcer, verrucous plaque, or chronic wound — particularly in immunosuppressed patients. Any chronic foot wound that fails standard wound care should be biopsied to exclude SCC or rare Marjolin’s ulcer transformation. Dr. Biernacki at Balance Foot & Ankle performs routine foot and ankle skin examinations and immediately refers suspicious pigmented lesions or non-healing wounds for dermatologic evaluation. Call (810) 206-1402 at our Bloomfield Hills or Howell office if you have a concerning lesion requiring evaluation.

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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

Book Online or call (810) 206-1402

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.