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Acral Lentiginous Melanoma: Distinct Subtype with Targeted Therapy Considerations

Rare melanoma subtype on palms, soles and subungual sites with distinct molecular landscape including KIT mutations, NRAS mutations and lower BRAF mutation rate

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Acral Lentiginous Melanoma: Distinct Subtype with Targeted Therapy Considerations?

Acral lentiginous melanoma is melanoma subtype on glabrous skin of palms, soles and subungual sites distinct from cutaneous melanoma.

Most common melanoma subtype in patients of African, Asian and Hispanic descent unlike cutaneous melanoma in fair-skinned populations.

Molecular profile distinct with lower BRAF V600E rate (15-20%), higher KIT (15-20%), more CDKN2A alterations.

Subungual location particularly thumb and great toe presents diagnostic challenge often confused with subungual hematoma.

Diagnostic delay with thicker tumors at diagnosis contributes to worse prognosis compared to cutaneous melanoma.

Symptoms

Pigmented lesion on palm, sole or under nail with irregular border, color variation and progressive growth.
Subungual lesion with longitudinal melanonychia exceeding 3 mm width or extending to nail fold (Hutchinson sign) suspicious.
Bleeding, ulceration, color change, asymmetry in acral pigmented lesion warrants urgent biopsy.
Late diagnosis with thicker primary tumors increases lymph node and distant metastasis risk.
Visceral metastases including lung, liver, brain may develop in advanced disease.

Risk Factors

Asian, African, Hispanic and other patients of color have higher relative incidence of acral lentiginous melanoma.
Age over 60 years with peak incidence in older adults.
Trauma may contribute to acral melanoma development though causal relationship debated.
Distinct molecular pathways with higher KIT, lower BRAF and complex chromosomal aberrations.
Lack of awareness leading to delayed presentation and diagnosis worsens prognosis.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Pigmented lesion on palm, sole or under nail with concerning features warrants dermatology evaluation and biopsy.
  • Subungual lesion with longitudinal melanonychia exceeding 3 mm width or Hutchinson sign requires biopsy.
  • Confirmed melanoma diagnosis on biopsy requires expedited multidisciplinary referral with sentinel lymph node biopsy assessment.
  • Advanced melanoma requires molecular profiling including BRAF, NRAS, KIT mutation testing to guide therapy.
  • Multidisciplinary care including dermatology, surgical oncology, medical oncology, podiatry for surgical reconstruction optimizes outcomes.

Treatment Methods

01
Wide local excision with appropriate margins based on Breslow thickness represents primary surgical treatment.
02
Sentinel lymph node biopsy for primary tumors greater than 0.8 mm thick or with adverse features.
03
KIT inhibitor imatinib provides treatment option for KIT-mutated metastatic disease with response rates 15-30%.
04
Immune checkpoint inhibitors including pembrolizumab and nivolumab provide treatment option though response rates may be lower than cutaneous melanoma.
05
Adjuvant therapy considerations for high-risk disease, comprehensive surveillance with awareness of distinct biology, attention to functional outcomes after acral surgery, multidisciplinary management with dermatology and surgical oncology, patient education about acral examination especially in high-risk populations, awareness of common diagnostic pitfalls including subungual lesions, and attention to underrepresented populations in melanoma research and care optimizes outcomes for this distinct melanoma subtype.

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