Skin cancer is not limited to traditionally sun-exposed areas such as the face and upper extremities. The feet and ankles—including the plantar surface and nail units—are frequently overlooked during both self-examinations and routine screenings, which can delay diagnosis.

Cutaneous malignancies of the lower extremity may present differently than those seen elsewhere on the body. Concerning clinical findings include longitudinal pigmented streaks within the nail plate, asymmetric or irregularly bordered lesions, changes in size or color, areas of unexplained discoloration on the plantar surface, and wounds that fail to heal within an expected timeframe. These presentations are often subtle and may be misattributed to trauma, fungal infection or other benign dermatologic conditions.

This misinterpretation contributes to delayed evaluation and, in some cases, more advanced disease at the time of diagnosis. In clinical practice, it is not uncommon to encounter lesions that have been present for extended periods under the assumption they were non-concerning.

While certain populations are at increased risk—including individuals with a history of significant sun exposure, fair skin, or prior skin cancer—malignancies of the foot and ankle can occur across all patient demographics. Notably, acral lentiginous melanoma, which occurs on the palms and soles, is not necessarily associated with sun exposure and may present in patients without traditional risk factors.

Routine inspection of the feet, ankles, and nail units is an essential component of skin surveillance. Particular attention should be directed toward areas that are less visible, including the bottoms of the feet and nail unit.  

Early recognition of suspicious findings and timely clinical evaluation remain critical factors in improving patient outcomes.  If you or a loved one, notice any concerning changes in the skin or nails, please call our office.  We are here to help!

William E. Donahue, DPM, FACFAS

Jennifer Zienkowski-Zubel, DPM