Melanoma of the hands or feet can be considerably more deadly than melanoma in other locations. It also is more common in people with darker skin. It is the most common type of melanoma in black and Asian populations. They are often deeper at diagnosis and can involve the nail apparatus. As a result, the photo submitted by this patient was very concerning. However on close inspection you can see the uniformity of pigment and the sharp smooth contours which are not typical of melanoma. The patient was instructed to come to the office where the lesion was opened with a scalpel and revealed to be a hematoma.
If you see a person with a “black eye,” you have to consider that person may have been the victim of an attack. In an injury like that, the dark color is caused by bleeding under the skin’s surface. The color is a dark purple almost becoming black. In these cases, even the blackest eyes have a little purple at the periphery and there is no primary change to the surface of the skin. On close inspection of this case, the color was a dark brown with no purple or red. There also was scale on the surface indicating dermatitis. What on first impression looks like a black eye, close inspection reveals that an attack did not occur. This “black eye” was actually seborrheic dermatitis. The patient cleared very nicely with hydrocortisone ointment.