Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
| Lesion Type | Appearance | Malignant Potential | Key Diagnostic Feature | Treatment |
|---|---|---|---|---|
| Subungual Melanoma | Dark longitudinal streak (melanonychia); irregular pigment bands; Hutchinson’s sign | High — 5-year survival 16–80% by stage | Hutchinson’s sign: pigment spreading to nail fold | Wide excision; ray amputation if advanced; sentinel node biopsy |
| Acral Lentiginous Melanoma | Irregular dark macule on sole or heel; can depigment in advanced stage | High — often diagnosed late (thick lesion) | Most common melanoma in darker skin tones; plantar sole location | Wide local excision (2cm margin); sentinel node; oncology referral |
| Squamous Cell Carcinoma (SCC) | Firm, ulcerated, keratotic nodule; may look like chronic wound or wart | Moderate-high; 3–5% metastasis if untreated | Chronic non-healing ulcer on sole/toe; biopsy confirms | Mohs surgery or wide excision; radiation if non-resectable |
| Basal Cell Carcinoma (BCC) | Pearly, translucent papule; rarely ulcerated on foot (uncommon location) | Low — rarely metastasizes; locally destructive | Rolled, pearly border; uncommon on foot | Excision; Mohs if near critical structures |
| Kaposi’s Sarcoma | Purple-red vascular papules; may involve foot/ankle | Moderate — associated with HIV/immunosuppression | Violaceous vascular tumor; check HIV status | Oncology referral; systemic therapy; radiation |
| ABCDE Criterion | Normal | Concerning Finding | Action Threshold |
|---|---|---|---|
| A — Asymmetry | Symmetric lesion halves | One half does not mirror the other | Biopsy if asymmetric + any other flag |
| B — Border | Smooth, well-defined edge | Irregular, notched, or satellite borders | Biopsy if border irregular |
| C — Color | Uniform single color | Multiple shades: black, brown, red, white, blue | Immediate biopsy if variegated color |
| D — Diameter | Under 6mm (pencil eraser) | Greater than 6mm or rapidly growing | Biopsy regardless of appearance if >6mm + change |
| E — Evolution | Unchanged for years | Any change in size, shape, color, or new symptom | Biopsy if any evolution — this is most sensitive criterion |
| F (added) — Funny-looking | Resembles other lesions on same patient | “Ugly duckling” — looks different from patient’s other moles | Clinical suspicion + biopsy |
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
The most important clinical decision with Skin Cancer Foot Ankle Melanoma Michigan Podiatrist isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Why Skin Cancer Occurs on the Foot
The foot and ankle are among the most commonly overlooked areas during skin cancer screening—even by dermatologists who may not routinely examine the plantar surface, interdigital spaces, and subungual (under-toenail) areas. Yet the foot harbors a disproportionate burden of acral lentiginous melanoma—a rare but aggressive subtype of melanoma that occurs on the palms, soles, and nail units and represents a higher proportion of melanoma in patients with darker skin tones. Unlike sun-exposed melanomas, acral lentiginous melanoma is not caused by UV radiation and therefore screening cannot rely on sun exposure history.
Warning Signs on the Foot and Ankle
Dr. Biernacki evaluates the foot and ankle at every visit for suspicious lesions using ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter greater than 6mm, and Evolution (changes over time). Plantar lesions that appear suddenly or change shape should be biopsied. Subungual melanoma typically presents as a longitudinal melanonychia—a dark brown or black vertical streak within the nail—that widens, changes color at the proximal nail fold (Hutchinson’s sign), or is associated with nail dystrophy. Any pigmented nail band that does not resolve with nail growth warrants urgent biopsy. Squamous cell carcinoma on the foot often presents as a non-healing ulcer or warty lesion.
In-Office Biopsy and Histopathology
Dr. Biernacki performs punch biopsies and shave excisional biopsies of suspicious foot skin lesions in-office under local anesthesia. Nail matrix biopsies for subungual pigmented streaks are performed with avulsion of the affected nail segment to access the matrix. All biopsy specimens are sent to dermatopathology for definitive histological diagnosis. Turnaround time is typically seven to ten days. Dr. Biernacki coordinates subsequent care with dermatology, surgical oncology, and plastic surgery based on pathology results—including wide local excision margins and sentinel lymph node biopsy when melanoma is confirmed.
Common Benign Foot Lesions vs. Malignant Lesions
Not all pigmented foot lesions are malignant—plantar melanocytic nevi (moles), blood blisters, and hemorrhage within callus are common benign mimics of melanoma. Dermatofibroma, clear cell acanthoma, and porokeratoma are additional benign entities that can alarm patients. Clinical dermoscopy allows Dr. Biernacki to identify features distinguishing benign from malignant lesions and appropriately triage lesions to observation vs. biopsy. Any lesion with clinical uncertainty receives a biopsy—the consequences of missing a melanoma far outweigh the minor morbidity of an in-office biopsy.
When to Seek Immediate Evaluation
Patients should seek urgent podiatric evaluation for any new dark streak under a toenail that was not caused by known trauma, any plantar lesion that has grown or changed in appearance over weeks to months, any non-healing plantar ulcer or warty growth that bleeds or does not respond to treatment, and any pigmented lesion with ABCDE features. Early stage melanoma on the foot is surgically curable with wide local excision—delayed diagnosis leads to regional lymph node metastasis and systemic disease with dramatically poorer outcomes. Annual foot skin inspection is appropriate for all adults.
Dr. Tom's Product Recommendations
Dermoscope Handheld Skin Scope (Heine Delta 20)
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Dermoscopy magnification tool used by Dr. Biernacki and skin cancer-aware patients to examine suspicious foot and nail lesions in detail, enhancing early melanoma detection.
Dr. Tom says: “While dermoscopes are primarily clinical tools, patient-level awareness and self-examination are important for early detection. Bring any concerns to your podiatry visit promptly.”
Patients who want to monitor suspicious foot lesions between visits under physician supervision
Those using dermoscopy as a substitute for professional biopsy—any concerning lesion must be evaluated by a physician
Disclosure: We earn a commission at no extra cost to you.
Blue Lizard Australian Sunscreen SPF 50+ (Fragrance Free)
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Broad-spectrum SPF 50+ sunscreen for the dorsal foot and ankle—the most commonly sun-exposed foot skin where squamous cell carcinoma and some melanomas develop in outdoor-active patients.
Dr. Tom says: “Sun protection on the dorsum of the foot is often forgotten. Blue Lizard’s mineral formula is appropriate for daily use on foot skin year-round.”
Outdoor-active Michigan patients protecting dorsal foot and ankle skin from UV exposure
Those who believe sunscreen prevents all foot skin cancers—acral melanoma is UV-independent
Disclosure: We earn a commission at no extra cost to you.
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Dr. Tom Biernacki’s Recommendation
Every year I find suspicious lesions during routine foot exams that patients had never noticed—including under toenails. Acral lentiginous melanoma is rare but deadly if caught late, and podiatrists are uniquely positioned to detect it early because we look at feet systematically. If something doesn’t look right, get it biopsied. That ten-minute procedure could save your life.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can I get a skin cancer check at a podiatry appointment?
Yes. Dr. Biernacki performs foot skin cancer screening as part of hands-on exam plus imaging when neededs. If you have any suspicious lesions on your feet or toenails, mention them at your appointment—or schedule a dedicated skin screening visit.
What is a dark streak under my toenail?
A dark streak (longitudinal melanonychia) under a toenail can be a benign nail matrix nevus, a fungal nail infection, or subungual melanoma. Any new streak that is widening, darkening, or associated with nail changes requires urgent podiatric or dermatologic evaluation and likely biopsy.
How long does a foot biopsy take to heal?
Most in-office punch biopsies heal within two to three weeks. Nail matrix biopsies take four to six weeks for the wound to heal and months for the new nail to grow back.
Is foot melanoma common?
Foot melanoma—particularly acral lentiginous melanoma—is rare overall but is the most common melanoma subtype in patients of African, Asian, and Hispanic descent. It’s among the deadliest forms due to frequent late diagnosis. Annual foot skin checks are appropriate for all adults.
Michigan Foot Pain? See Dr. Biernacki In Person
4.9★ rated | 1,123 Reviews | 3,000+ Surgeries
Same-week appointments · Howell & Bloomfield Hills
📞 (810) 206-1402 Book Online →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.
Visit Balance Foot & Ankle — Same-Day Appointments Available
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.
American Academy of Dermatology: Skin Cancer
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.