Talon Noir
Charlotte Brammer
Editor: Dr Daniel Keith
What is Talon noir?
Talon noir means ‘black heel’ and is a benign, often self-limiting diagnosis which appears as dark red or black spots on the skin. This is caused by a collection of blood under the stratum corneum and is often caused by shearing trauma but can also occur spontaneously without a history of trauma, especially when on the foot. ‘Talon’ refers to a lesion on the heel, but they can appear in other regions of the body such as the hands, thumbs and toes. Tache noire refers to the same diagnosis but on the palm.
Talon noir is asymptomatic and usually resolves within 3-4 weeks. Due to their dark colouring and sometimes irregular border, they can be mistaken for a malignant melanoma.
What is Talon noir?
Talon noir means ‘black heel’ and is a benign, often self-limiting diagnosis which appears as dark red or black spots on the skin. This is caused by a collection of blood under the stratum corneum and is often caused by shearing trauma but can also occur spontaneously without a history of trauma, especially when on the foot. ‘Talon’ refers to a lesion on the heel, but they can appear in other regions of the body such as the hands, thumbs and toes. Tache noire refers to the same diagnosis but on the palm.
Talon noir is asymptomatic and usually resolves within 3-4 weeks. Due to their dark colouring and sometimes irregular border, they can be mistaken for a malignant melanoma.
What does Talon noir look like macroscopically?
Talon noir presents as flat, dark macules on the posterior or posterolateral aspect of the heel. They often have well-defined borders and are very superficial. Talon noir can look like a single patch of pigmentation or a cluster of pinpricks of blood. They can be different colours including brown, black and deep red.
Here is a macroscopic view of a Talon noir presenting on the posterior aspect of the heel. The circular lesion has a deep red colour, a well-defined border and a flat texture.
Image provided by Dr James Case, GP.
Talon noir can also present on the metatarsals and palms of the hands. This may be due to taking part in racquet sports or specific activities which generate a particular area of friction.
What does Talon noir look like on dermoscopy?
Talon noir can have several different formations including:
-
A horizontal ridge formation of colour arranged in parallel lines
-
Several peripheral petechiae making up the lesion in a globular formation
-
A homogenous formation where it is the same morphology throughout
These formations all represent intracorneal haemorrhage where blood is within the stratum corneum. They will have a reddish-brown colouration and a well-circumscribed edge.
Above is a view of a Talon noir through a dermoscope. The lesion demonstrates haemorrhagic material arranged in a parallel ridge formation. Malignant melanoma may also display this type of formation, so it is important to try and pare it down with a blade to diagnosis Talon noir.
Here is a homogenous formation of Talon noir with a noticeably sharp defined boundary and a reddish-brown colour.
How do you differentiate between Talon noir and malignant melanoma?
To distinguish between talon noir and specifically acral melanoma, a dermoscope can be used. Talon noir is more likely to have a reddish-black colour with well-defined edges. Talon noir is also more likely to have a homogenous or globular pattern. However, acral melanoma has a more brown-black appearance with a parallel ridge pattern and an irregular border.
In talon noir the haemorrhagic material is more superficial and the stratum corneum can be pared with a blade to shave down the blood cells in this layer, which can help to aid a diagnosis of talon noir. Conversely, in melanoma the lesion reaches deeper and cannot be pared down with a blade to remove the pigment.
What is the treatment and diagnosis of Talon noir?
Talon noir needs several weeks to recover on its own as it is a benign, self-limiting condition. The progress of resolution can be accelerated by:
-
Scraping down the skin with a blade to remove the superficial layers of pigment
-
Giving lifestyle advice including wearing comfortable footwear and thick socks
-
Moisturising the area and reducing friction and shearing forces that may have caused the lesion