Question:medium

A patient has an irregular black pigmented lesion on the heel/sole suspicious for acral melanoma. The most appropriate confirmatory investigation is:

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Pigmented lesion suspicious of melanoma - only tissue (biopsy) confirms it.
Updated On: Jun 25, 2026
  • Excisional / full-thickness biopsy with histopathology
  • KOH mount / Gram stain
  • Tzanck smear
  • Wood's lamp examination
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The Correct Option is A

Solution and Explanation

The clinical concern here is a pigmented lesion on a weight-bearing acral site - the heel - which raises the spectre of $acral$ $lentiginous$ $melanoma$, the melanoma variant disproportionately seen on palms, soles and nail beds in pigmented skin.

The fundamental rule for any lesion suspected of being melanoma is that diagnosis is $histological$. You cannot confirm or exclude melanoma by a smear or a lamp; you need tissue. The preferred procedure is an $excisional$ biopsy taken through the full thickness of skin so the pathologist can report depth of invasion ($Breslow$ thickness), ulceration and mitotic rate - the very parameters that determine prognosis and the width of subsequent wide local excision.

The competing options test whether the candidate confuses investigations: a $KOH$ preparation is for dermatophytes, a Gram stain for bacteria, a $Tzanck$ smear for herpetic/varicella vesicles or acantholytic pemphigus cells, and Wood's lamp for fluorescent infections or pigment localisation. None can establish a tissue diagnosis of malignancy.

\[\boxed{\text{Investigation of choice} = \text{Biopsy (histopathology)}}\]
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