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Talon noir - Skin
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Talon noir - Skin

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Contributors: Stephen Huang MD, Whitney A. High MD, JD, MEng, Jeffrey D. Bernhard MD, Belinda Tan MD, PhD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Talon noir is an asymptomatic discoloration of acral skin that results from intraepidermal hemorrhage caused by shear-force injuries. Talon noir translated from French means black heel (also known as calcaneal petechiae). It most aptly describes lesions upon the feet, particularly the heel, but lesions upon the hand (tache noir) also occur. Some dermatologists use the same nosology to refer to both processes. Because the condition can be seen in varied locations and for varied reasons, some dermatologists have suggested the term post-traumatic cutaneous intracorneal blood.

Talon noir tends to affect the posterior foot, the heel, the lateral foot, and the palm. Athletic events often produce shearing forces that give rise to the lesion. Basketball, lacrosse, football, soccer, and cross-country running are frequent causes of talon noir and tache noir.

The condition is asymptomatic, and because it is painless, the etiological events are often unrecognized. Because of the discoloration and generally rapid acquisition, patients may be concerned that they have an acral melanoma.

Codes

ICD10CM:
S90.30XA – Contusion of unspecified foot, initial encounter

SNOMEDCT:
238479007 – Talon noir

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acral melanoma – If dyspigmentation does not resolve with superficial paring, the concern for melanoma is amplified. Lesions suspected of being even a possible melanoma should be pursued with appropriate referral to dermatology and a possible biopsy.
  • Acral nevus – Also a melanocytic process that is readily appreciated on biopsy.
  • Traumatic tattoo – Implantation of exogenous pigmented material, such as graphite or other carbon material, is not Hemoccult positive.
  • Verruca vulgaris – Sometimes dilated and thrombosed capillaries may be seen in the center of the wart, but usually this is very punctate in nature, and other features such as interruption of skin lines indicate that a verruca is present.
  • Tinea nigra – A rare fungal infection with an organism that produces its own melanin-based pigment. The fungus is readily seen on biopsy because of this endogenous pigment production.

Best Tests

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Therapy

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References

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Last Updated: 03/11/2015
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Talon noir - Skin
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Talon noir : Hyperpigmented macule, Palm, Sporting activity, Trauma, Plantar foot
Clinical image of Talon noir
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