The authors describe an atypical presentation of a malignant melanoma lesion identified as decubitus ulceration on the heel of a patient with diabetes mellitus complicated by peripheral neuropathy. The patient was treated at multiple institutions with routine debridement and conservative therapy with negligible improvement in wound appearance. The wound appeared viable, and a dermatological allograft procedure was attempted. Failure of the allograft prompted a soft tissue biopsy of the ulcerated area that revealed malignant melanoma. This is a rare yet solemn finding that may easily be overlooked in the neuropathic population.

Vascular spasm – cardiac depression,
The patient has learned this vital lesson,
High blood glucose – occluded blood flow,
Induced cyanosis within the great toe,
Metformin used for diabetes control,
A perforating ulcer – a necrotised hole,
Swelling causes endothelial changes,
Poor glucose control stimulates dangers,
Osteomyelitis of the talus,
Charcot joint with thickened callus,
Proliferation of the skin,
Destructive phase will now begin,
Inflammation – T cell divide,
Immune response this will provide
Nitric Oxide – glucose is changed,
Into fructose – covalent bonds rearrange,
Glucose attached to blood corpuscles,
Decrease in oxygen – ischemic muscles,
Red cells cling to capillary walls,
Eventually blood flow stops or stalls,
Prothrombin converts in clotting cascade,
Respectively a fibrin meshwork is made,
A thrombus is formed – risk of a stroke,
Vasoconstriction – why do you smoke?
Dermatophyte thriving between the toes,
As blood glucose rises – fungus grows,
Good control of diabetes,
Means that you can earn your sweeties
Blood glucose of four to nine,
In good control – this reading’s fine.