Acral (volar—subungual) melanoma

Abstract

Acral melanoma occurs in the volar surface of the hands, feet, fingers, toes and subungual sites. Recently it has been recognized as a distinct entity with characteristic clinical and pathological features. Of our 340 patients with malignant melanoma, 24 (7 per cent) had acral melanoma. Sixteen were in the plantar skin, two in the palms and six in the nailbed. The delay in diagnosis was 6 months to 5 years and most of the patients presented with large neglected tumours. Fourteen lesions had histological features consistent with acral lentiginous melanoma - a unique pattern to this area. Fourteen patients were in clinical stage I at diagnosis, seven in stage II and three had distant metastases (stage III). The treatment was mainly surgical. Palmar-plantar lesions were widely excised. One patient underwent below-knee amputation. Lesions of the digits were treated by amputation of the affected toe. Fourteen of the patients underwent either prophylactic or therapeutic lymph node dissection. In 9 of them, regional metastases were found. In patients with advanced disease chemotherapy was added. Three patients had isolated limb perfusion. Fourteen patients died of metastatic disease within 1-5 years. Four are alive but have metastatic spread. Six patients are disease-free, one to 4.5 years following diagnosis.

Acral cutaneous melanoma in caucasians: clinical features, histopathology and prognosis in 112 patients

“…This is probably due to an earlier diagnosis after more public campaigns and to a more recent cohort of patients. As in the present studies, previous reports have demonstrated that most ALM occur on plantar sites and few on palmar sites, 4,6 , 7,15 , 16 also that subungual melanomas occur more often on the hands than on the feet. 17–20 …”

Acral with melanoma: A review of 185 patients identification of prognostic variables

“…This difference has been attributed to the misdiagnoses and the delays in diagnosis that are common for plantar and subungual melanomas. Acral melanomas are often misdiagnosed or ignored before an accurate diagnosis is made [5,6]. Plantar melanomas are hidden from view and may be mistaken for warts, and subungual melanomas are often mistaken for subungual hematomas before the correct diagnosis is made [5].…”

Acral Melanoma in Chinese: A Clinicopathological and Prognostic Study of 142 cases

“…AM is rare in Caucasians (1–7%) but has higher incidence in non-White individuals345678, accounting for up to 58% of all cutaneous melanomas in Asians9 and even more (60–70%) in Blacks10. It is often misdiagnosed or ignored before an accurate diagnosis is made because it is hidden from view1112. Furthermore, AM may represent a more biologically aggressive melanoma subtype and is thought to carry a worse prognosis when compared with other melanoma subtypes1213141516.…”