Asymptomatic Black Macules over the Feet in an Adolescent

A 14 year old boy presented with complaints of an asymptomatic blackish lesion on the bilateral feet, which was increased in size from the past 3 months. On examination, there were two blackish–brown macules of irregular shape and borders and of size 3 cm × 2 cm present symmetrically over the bilateral calcaneal tuberosity [Figure 1]. A dermoscopy of the lesions showed multiple blackish dots and globules and a few reddish–brown dots over a light brown background [Figure 2]. On further history taking, the patient was told about recent engagement in volleyball practice from the past 5 to 6 months. A diagnosis of talon noir (calcaneal petechiae) was made. On the paring of the lesions, islands of color were removed with normal-looking skin underneath it.Figure 1: Two well-defined blackish plaques present symmetrically over the bilateral heelsFigure 2: Dermoscopy of the lesion showing multiple blackish dots and globules and a few satellite reddish brown dots present over a light brown backgroundCalcaneal petechiae or black heel is a trauma-induced darkening of the skin seen usually in athletes and people walking barefoot. Shearing trauma induces hemorrhage in the papillary dermis and transepidermal elimination of blood through the sweat ducts lead to formation of intracorneal deposits of hemoglobin.[1] It can mimic many diseases such as melanoma, pigmented basal cell carcinoma, seborrheic keratosis, and fixed drug eruption.[2] The reddish hue of the lesions and the presence of satellite reddish dots and globules on dermoscopy are crucial findings to differentiate calcaneal petechiae from other sinister diseases like melanoma.[2] In conclusion, in any case of acral pigmented lesion, dermoscopy should be the first auxiliary tool to be used in the management. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s)/guardian(s) of the patient. In the form, the parent(s)/guardian(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.