The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 
years) with plantar melanoma over a 13-year period was analysed to evaluate the 
efficacy of wide local excision with split skin grafting. Substantial delay in 
seeking medical attention occurred in 35 patients. At presentation, 20 patients 
had stage I disease, one stage II, 15 stage III and four stage IV. Acral 
lentiginous melanoma (27 patients) was the most common histological type. The 
mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or 
V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision 
with split skin grafting was used in 29 patients; four patients with neglected 
advanced plantar lesions had below-knee amputation and seven with metastatic 
disease did not undergo surgery. Graft sepsis occurred in six patients and local 
recurrence in two. Nine patients were alive at follow-up; the 5-year survival 
rate was 25 per cent. Delay in presentation and locally advanced disease may 
explain the poor prognosis of plantar melanoma in black South Africans.