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Acral lentiginous melanoma
Classification and external resources
ICD-10	C43
ICD-9	172.0-173.9
ICD-O:	M8744/3

Acral lentiginous melanoma is a kind of lentiginous^[1] skin melanoma.^[2]:695 It is also known as subungual melanoma.

Acral lentiginous melanoma is observed on the palms, soles and under the nails.^[3] It occurs on non hair-bearing surfaces of the body which may or may not be exposed to sunlight. It is also found on mucous membranes. Unlike other forms of melanoma, acral lentiginous melanoma does not appear to be linked to sun exposure.

It is the most common form of melanoma diagnosed amongst Asian and Black ethnic groups.^{[citation needed]} The average age at diagnosis is between sixty and seventy years.^{[citation needed]} The melanoma is also diagnosed in Caucasians and in young people.^{[citation needed]}

Contents 1 Diagnosis 2 Signs and Symptoms 3 Histology 4 Famous cases 5 See also 6 References 7 External links

[edit] Diagnosis

Even though the ideal method of diagnosis of melanomas should be complete excisional biopsy, the location of the acral (surrounding) lentiginous melanoma requires alternatives.

Dermatoscopy of acral pigmented lesions is very difficult, but can be accomplished with diligent attention.

Initial confirmation of the suspicion can be done with a small wedge biopsy or small punch biopsy. Thin deep wedge biopsies can heal very well on acral skin, and small punch biopsies can give enough clue to the malignant nature of the lesion. Once this confirmatory biopsy is done, a second complete excisional skin biopsy can be performed with a narrow surgical margin (1 mm). This second biopsy will determine the depth and invasiveness of the melanoma, and will define what the final treatment will be. If the melanoma involves the nail fold and the nail bed, complete excision of the nail unit might be required.

Final treatment might require wider excision (margins of 0.5 cm or more), digital amputation, lymphagiogram with lymphnode dissection, or chemotherapy.

[edit] Signs and Symptoms

Typical signs of acral lentiginous melanoma include^{[citation needed]}:

• longitudinal tan, black, or brown streak on a finger or toe nail (melanonychia striata)
• pigmentation of proximal nail fold
• areas of dark pigmentation on palms of hands or soles of feet

Warning signs are new areas of pigmentation, or existing pigmentation that shows change.^{[citation needed]} If caught early, acral lentiginous melanoma has a similar cure rate as the other types of superficial spreading melanoma.^{[citation needed]}

There are usually no symptoms for melanomas until it is too advanced.^{[citation needed]}

[edit] Histology

Histological signs of acral lentiginous melanoma include:

• atypical melanocytes in junctional nests
• dermal invasion
• desmoplasia
• hyperplasticity of the skin

[edit] Famous cases

Bob Marley's death was caused by acral lentiginous melanoma present under one of his toenails.^[4]

[edit] See also

• Melanoma
• List of cutaneous conditions

[edit] References

[edit] External links

• Histology
• GP Notebook

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