Masked pressure lesion on the tip of the toe, a diagnostic challenge

Summary Amelanotic acral melanoma is an uncommon melanoma subtype often associated with delayed diagnosis due to its nonpigmented and clinically inconspicuous presentation. We report the case of a 61-year-old man presenting with a painful erythematous nodule on the plantar aspect of the second toe persisting for 1 year and initially presumed benign. Histopathological evaluation confirmed acral amelanotic melanoma (pT3a) with micrometastatic sentinel lymph node involvement. The patient underwent partial toe amputation followed by adjuvant immunotherapy with nivolumab. This case underscores the importance of early biopsy of persistent acral lesions to reduce diagnostic delay and improve outcomes.