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Pedal Melanotic Schwannoma: A Case Report

Glenn Woodley, Mark Micciche and Dana Klush

Background: Melanotic or melanocytic schwannoma is a rare variant of a schwannoma. It is composed of melanin-producing cells with the ultra-structural features of Schwann cells along with the cytoplasmic deposition of melanin. The occurrence of a melanotic schwannoma is particularly rare in the foot. Regardless of anatomic location, they are considered to be benign soft tissue masses.

Case description: A 78 year old Caucasian female presented to a physician’s office with complaints of onchyomycosis. Incidentally, it was noted that the patient had large a mass on the plantar aspect of her right foot. She denied any complaints regarding the mass. The mass had been present for approximately one year and was slowly increasing in size. An MRI revealed a heterogeneous macrolobulated mass measuring 3.0 × 8.3 × 5.3 cm and could not rule out malignancy. A surgical biopsy was then performed.

Conclusion: Melanotic schwannomas have the ability to mirror malignancy, both on physical exam and on advanced imaging modalities. A biopsy procedure provides a definitive diagnosis and contributes to the definitive treatment plan.