Rong Khaw is a Consultant Plastic Surgeon based at the Department of Plastic Reconstructive Surgery of Countess of Chester Hospital. Her special interest includes hand & breast reconstructive surgery.

Background: Incidence of malignant melanoma in the UK has quadrupled since 1970s and accounts for 90% of skin cancer mortality. Atypical melanoma is often mistaken clinically for other skin tumours such as pigmented basal cell carcinoma, pyogenic granuloma or even seborrheic keratosis. The case report highlights the uncommon clinical features of this aggressive skin cancer. Case report: An 83-year-old woman was referred for a suspected squamous cell carcinoma on her chin. She reported a 5-week history of an itchy nodule which did not change in size or bled. She was previously treated for actinic keratosis to her right lower eyelid. She has neither personal nor family history of skin cancer and reports spending 14 years in Middle East earlier in her life. Examination revealed a 1cm well defined, skin coloured, keratotic nodule with central ulceration which scored only two out of seven points on Glasgow checklist for skin cancers. Excision biopsy results revealed a focally ulcerating, superficial spreading non-pigmented melanoma with Breslow thickness 2.5mm.

Conclusion: Uncommon presentations of malignant melanoma are pedunculated, polypoid, amelanotic or hyperkeratotic. It is of paramount importance that clinicians are familiar with rare variations as this could alter the referral pathway, biopsy methods and subsequent management.