Talon Noir

A 17-year-old high school athlete was anxious about this new “mole” that appeared on the heel of his right foot. His concern was prompted by the recent diagnosis of melanoma in his aunt.

This is talon noir, or black heel, an asymptomatic lesion composed of singular and confluent petechiae and purpura on the foot, especially the plantar and lateral heel pads. It is caused by athletic maneuvers that require frequent starts and stops; hence, it is seen most often in basketball players and those who play racquet sports.

Because of the thickness of the epidermis on the feet, these lesions appear dark and sharply circumscribed and may mimic a mole or a melanoma. The magnified appearance, the clinical history, and the eruption's location are very important in making the diagnosis. If there is any question, a biopsy is indicated.

A pearl to the diagnosis of talon noir: as seen in the lesion pictured here, the petechiae often follow the dermatoglyphic patterns (ie, the cutaneous ridges: whorl, loop, and arch) of the foot pad.