Acral lentiginous melanoma

Last updated
Acral lentiginous melanoma
Melanoma (1).jpg
Specialty Oncology, dermatology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Areas of dark pigmentation [1]
CausesMalignant melanocytes [2] [3]
Diagnostic method Biopsy [4]
TreatmentBiologic immunotherapy agents [5]
FrequencyMales = Females [6]

Acral lentiginous melanoma is a type of skin cancer. [6] It typically begins as a uniform brownish mark before becoming darker and wider with a blurred irregular edge, most frequently seen in the foot of a person with darker skin. [6] It may become bumpy and ulcerate. [6] Just under the nail it typically appears as dark longitudinal streaks, and it may spread. [7]

Contents

Melanoma is a group of serious skin cancers that arise from pigment cells (melanocytes); acral lentiginous melanoma is a kind of lentiginous [8] skin melanoma. [6] Acral lentiginous melanoma is the most common subtype in people with darker skins and is rare in people with lighter skin types. [7] It is not caused by exposure to sunlight or UV radiation, and wearing sunscreen does not protect against it. Acral lentiginous melanoma is commonly found on the palms, soles, under the nails, and in the oral mucosa. It occurs on non-hair-bearing surfaces of the body, which have not necessarily been exposed to sunlight. It is also found on mucous membranes. [9]

The absolute incidence of ALM is the same for people of all skin colors, and has not changed significantly for decades. [9] However, because rates of other melanomas are low in non-white populations, ALM is the most common form of melanoma diagnosed amongst Asian and sub-Saharan African ethnic groups. [10] The average age at diagnosis is between sixty and seventy years. [11]

Males and females are affected equally. [6]

Signs and symptoms

Typical signs of acral lentiginous melanoma include the following [1]

Warning signs are new areas of pigmentation, or existing pigmentation that shows change. If caught early, acral lentiginous melanoma has a similar cure rate as the other types of superficial spreading melanoma. [12]

Causes

Acral lentiginous melanoma is a result of malignant melanocytes at the membrane of the skin (outer layers). [2] [3] The pathogenesis of acral lentiginous melanoma remains unknown at this time. [13] It is not caused by sunlight or UV radiation. [9]

Diagnosis

Although the ideal method of diagnosis of melanoma is complete excisional biopsy, [14] alternatives may be required according to the location of the melanoma. Dermatoscopy of acral pigmented lesions is very difficult but can be accomplished with diligent focus. Initial confirmation of the suspicion can be done with a small wedge biopsy or small punch biopsy. [4] 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, [15] and will help to 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, lymphangiogram with lymph node dissection, or chemotherapy. [16]

Histology

Acral lentiginous melanoma (ALM) Skin Tumors-027.jpg
Acral lentiginous melanoma (ALM)

The main characteristic of acral lentiginous melanoma is continuous proliferation of atypical melanocytes at the dermoepidermal junction. [17] Other histological signs of acral lentiginous melanoma include dermal invasion and desmoplasia. [18]

According to Scolyer et al., [19] ALM "is usually characterized in its earliest recognisable form as single atypical melanocytes scattered along the junctional epidermal layer".

Treatment

Therapies for metastatic melanoma include the biologic immunotherapy agents ipilimumab, pembrolizumab, and nivolumab; BRAF inhibitors, such as vemurafenib and dabrafenib; and a MEK inhibitor trametinib. [5]

When arising in the nailbed of a digit, the evidence suggests that digit-sparing surgery (wide excision and grafting) has similar outcomes to amputation, [20] therefore, to preserve function it is recommended that clinicians default to digit-sparing surgery and if the margins are involved or patients develop recurrence, then secondary amputation can be considered.

Prognosis

It has been demonstrated that acral lentiginous melanoma has a poorer prognosis compared to that of cutaneous malignant melanoma (CMM). [21]

Society and culture

Jamaican musician Bob Marley died of the condition in 1981, at the age of 36. [22]

See also

Related Research Articles

<span class="mw-page-title-main">Melanocytic nevus</span> Skin condition, mole

A melanocytic nevus is usually a noncancerous condition of pigment-producing skin cells. It is a type of melanocytic tumor that contains nevus cells. Some sources equate the term mole with "melanocytic nevus", but there are also sources that equate the term mole with any nevus form.

<span class="mw-page-title-main">Melanocyte</span> Melanin-producing cells of the skin

Melanocytes are melanin-producing neural crest-derived cells located in the bottom layer of the skin's epidermis, the middle layer of the eye, the inner ear, vaginal epithelium, meninges, bones, and heart. Melanin is a dark pigment primarily responsible for skin color. Once synthesized, melanin is contained in special organelles called melanosomes which can be transported to nearby keratinocytes to induce pigmentation. Thus darker skin tones have more melanosomes present than lighter skin tones. Functionally, melanin serves as protection against UV radiation. Melanocytes also have a role in the immune system.

<span class="mw-page-title-main">Melanoma</span> Cancer originating in melanocytes

Melanoma is the most dangerous type of skin cancer; it develops from the melanin-producing cells known as melanocytes. It typically occurs in the skin, but may rarely occur in the mouth, intestines, or eye. In women, melanomas most commonly occur on the legs; while in men, on the back. Melanoma is frequently referred to as malignant melanoma. However, the medical community stresses that there is no such thing as a 'benign melanoma' and recommends that the term 'malignant melanoma' should be avoided as redundant.

<span class="mw-page-title-main">Nevus</span> Mole or birthmark; visible, circumscribed, chronic skin lesion

Nevus is a nonspecific medical term for a visible, circumscribed, chronic lesion of the skin or mucosa. The term originates from nævus, which is Latin for "birthmark"; however, a nevus can be either congenital or acquired. Common terms, including mole, birthmark, and beauty mark, are used to describe nevi, but these terms do not distinguish specific types of nevi from one another.

<span class="mw-page-title-main">Superficial spreading melanoma</span> Medical condition

Superficial spreading melanoma (SSM) is a type of skin cancer that typically starts as an irregularly edged dark spot typically on sun-exposed part of the body. The colour may be variable with dark, light and reddish shades; occasionally no color at all. It typically grows in diameter before spreading to deeper tissue, forming a bump or becoming an ulcer. Itching, bleeding and crust formation may occur in some. The backs and shoulders of males and legs of women are particularly prone.

<span class="mw-page-title-main">Dysplastic nevus</span> Medical condition

A dysplastic nevus or atypical mole is a nevus (mole) whose appearance is different from that of common moles. In 1992, the NIH recommended that the term "dysplastic nevus" be avoided in favor of the term "atypical mole". An atypical mole may also be referred to as an atypical melanocytic nevus, atypical nevus, B-K mole, Clark's nevus, dysplastic melanocytic nevus, or nevus with architectural disorder.

<span class="mw-page-title-main">Lentigo maligna melanoma</span> Medical condition

Lentigo maligna melanoma is a melanoma that has evolved from a lentigo maligna, as seen as a lentigo maligna with melanoma cells invading below the boundaries of the epidermis. They are usually found on chronically sun damaged skin such as the face and the forearms of the elderly.

<span class="mw-page-title-main">Lentigo maligna</span> Medical condition

Lentigo maligna is where melanocyte cells have become malignant and grow continuously along the stratum basale of the skin, but have not invaded below the epidermis. Lentigo maligna is not the same as lentigo maligna melanoma, as detailed below. It typically progresses very slowly and can remain in a non-invasive form for years.

<span class="mw-page-title-main">Dermatoscopy</span> Medical examination of the skin

Dermatoscopy, also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The dermatoscope consists of a magnifier, a light source, a transparent plate and sometimes a liquid medium between the instrument and the skin. The dermatoscope is often handheld, although there are stationary cameras allowing the capture of whole body images in a single shot. When the images or video clips are digitally captured or processed, the instrument can be referred to as a digital epiluminescence dermatoscope. The image is then analyzed automatically and given a score indicating how dangerous it is. This technique is useful to dermatologists and skin cancer practitioners in distinguishing benign from malignant (cancerous) lesions, especially in the diagnosis of melanoma.

<span class="mw-page-title-main">Lentigo</span> Small pigment spots on skin

A lentigo is a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. It is a harmless (benign) hyperplasia of melanocytes which is linear in its spread. This means the hyperplasia of melanocytes is restricted to the cell layer directly above the basement membrane of the epidermis where melanocytes normally reside. This is in contrast to the "nests" of multi-layer melanocytes found in moles. Because of this characteristic feature, the adjective "lentiginous" is used to describe other skin lesions that similarly proliferate linearly within the basal cell layer.

<span class="mw-page-title-main">Blue nevus</span> Type of melanocytic tumor

A blue nevus is a type of coloured mole, typically a single well-defined blue-black bump.

<span class="mw-page-title-main">Skin biopsy</span> Removal of skin cells for medical examination

Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists. Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a skin biopsy can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery.

<span class="mw-page-title-main">Amelanotic melanoma</span> Medical condition

Amelanotic melanoma is a type of skin cancer in which the cells do not make any melanin. They can be pink, red, purple or of normal skin color, and are therefore difficult to diagnose correctly. They can occur anywhere on the body, just as a typical melanoma can.

Melanonychia is a black or brown pigmentation of a nail, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such localized events as lichen planus or fixed drug eruption.

Longitudinal erythronychia presents with longitudinal red bands in the nail plate that commence in the matrix and extend to the point of separation of the nail plate and nailbed, and may occur on multiple nails with inflammatory conditions such as lichen planus or Darier's disease. Longitudinal erythronychia is usually asymptomatic but can sometimes be associated with pain.

<span class="mw-page-title-main">Benign melanocytic nevus</span> Medical condition

A benign melanocytic nevus is a cutaneous condition characterised by well-circumscribed, pigmented, round or ovoid lesions, generally measuring from 2 to 6 mm in diameter. A benign melanocytic nevus may feature hair or pigmentation as well.

Pseudomelanoma is a cutaneous condition in which melanotic skin lesions clinically resemble a superficial spreading melanoma at the site of a recent shave removal of a melanocytic nevus.

Oral pigmentation is asymptomatic and does not usually cause any alteration to the texture or thickness of the affected area. The colour can be uniform or speckled and can appear solitary or as multiple lesions. Depending on the site, depth, and quantity of pigment, the appearance can vary considerably.

<span class="mw-page-title-main">Acral nevus</span> Medical condition

An acral nevus is a cutaneous condition of the palms, soles, fingers, or toes, characterized by a skin lesion that is usually macular or only slightly elevated, and may display a uniform brown or dark brown color, often with linear striations.

Animal-type melanoma is a rare subtype of melanoma that is characterized by heavily pigmented dermal epithelioid and spindled melanocytes. Animal-type melanoma is also known to be called equine-type melanoma, pigment synthesizing melanoma, and pigmented epithelioid melanocytoma (PEM). While melanoma is known as the most aggressive skin cancer, the mortality for PEM is lower than in other melanoma types. Animal-type melanoma earned its name due to the resemblance of melanocytic tumors in grey horses.

References

  1. 1 2 Goodheart HP (2010-10-25). Goodheart's Same-site Differential Diagnosis: A Rapid Method of Diagnosing and Treating Common Skin Disorders. Lippincott Williams & Wilkins. ISBN   978-1-60547-746-6.
  2. 1 2 Brown KM, Chao C (2014). Melanoma. Elsevier Health Sciences. ISBN   978-0-323-32683-4. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  3. 1 2 Piliang MP (June 2011). "Acral Lentiginous Melanoma". Clinics in Laboratory Medicine. 31 (2): 281–288. doi:10.1016/j.cll.2011.03.005. PMID   21549241.  via ScienceDirect  (Subscription may be required or content may be available in libraries.)</
  4. 1 2 ChB DE, PhD SJ (2014-11-10). Superficial Melanocytic Pathology. Demos Medical Publishing. ISBN   978-1-62070-023-5. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  5. 1 2 Maverakis E, Cornelius LA, Bowen GM, Phan T, Patel FB, Fitzmaurice S, He Y, Burrall B, Duong C, Kloxin AM, Sultani H, Wilken R, Martinez SR, Patel F (2015). "Metastatic melanoma - a review of current and future treatment options". Acta Derm Venereol. 95 (5): 516–524. doi: 10.2340/00015555-2035 . PMID   25520039. Archived from the original on 2018-07-19. Retrieved 2018-11-04.
  6. 1 2 3 4 5 6 James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I (2020). "30. Melanocytic nevi and neoplasms". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. pp. 696–697. ISBN   978-0-323-54753-6.
  7. 1 2 Hall KH, Rapini RP (2024). "Acral Lentiginous Melanoma". StatPearls. StatPearls Publishing. PMID   32644539.
  8. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L (2007). "Acral lentiginous melanoma: histopathological prognostic features of 121 cases". British Journal of Dermatology. 157 (2): 311–318. doi:10.1111/j.1365-2133.2007.08031.x. ISSN   1365-2133. PMID   17596173. S2CID   40412082.
  9. 1 2 3 LeBoit PE (2006). Pathology and Genetics of Skin Tumours. IARC. ISBN   978-92-832-2414-3.
  10. Farage MA (2010-01-22). Textbook of Aging Skin. Springer Science & Business Media. ISBN   978-3-540-89655-5. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  11. Swartz MH (2014-01-07). Textbook of Physical Diagnosis: History and Examination. Elsevier Health Sciences. ISBN   978-0-323-22507-6. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  12. Hearing VJ, Leong SP (2007-11-05). From Melanocytes to Melanoma: The Progression to Malignancy. Springer Science & Business Media. ISBN   978-1-59259-994-3.
  13. David E. Elder, Sook Jung Yun (2014-11-10). Superficial Melanocytic Pathology. Demos Medical Publishing. p. 119. ISBN   978-1-61705-186-9 . Retrieved 11 October 2016.
  14. Shea CR, Reed JA, Prieto VG (2014-11-03). Pathology of Challenging Melanocytic Neoplasms: Diagnosis and Management. Springer. ISBN   978-1-4939-1444-9. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  15. Barnhill RL, Piepkorn M, Busam KJ (2014-02-18). Pathology of Melanocytic Nevi and Melanoma. Springer Science & Business Media. ISBN   978-3-642-38385-4. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  16. Clarke LE, Clarke JT, Helm KF (2014-03-01). Color Atlas of Differential Diagnosis in Dermatopathology. JP Medical Ltd. ISBN   978-93-5090-845-7. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  17. Piliang MP (2009). "Acral Lentiginous Melanoma". Surgical Pathology Clinics. 2 (3): 535–541. doi:10.1016/j.path.2009.08.005. ISSN   1875-9181. PMID   26838538.
  18. Mooi W, Krausz T (2007-09-28). Pathology of Melanocytic Disorders 2ed. CRC Press. ISBN   978-1-4441-1380-8. Archived from the original on 2023-01-11. Retrieved 2020-12-06.
  19. "FEBS Press". doi:10.1002/(ISSN)1878-0261. Archived from the original on 2021-08-31. Retrieved 2015-05-23.
  20. Hardie CM, Wade RG, Wormald JC, Stafford B, Elliott F, Newton-Bishop J, Dewar D (2023). "Surgical excision methods for skin cancer involving the nail unit: A systematic review". Cochrane Evidence Synthesis and Methods. 1 (8). doi: 10.1002/cesm.12026 . ISSN   2832-9023.
  21. Bradford PT, Goldstein AM, McMaster ML, Tucker MA (2009). "Acral Lentiginous Melanoma: Incidence and Survival Patterns in the United States, 1986-2005". Archives of Dermatology. 145 (4): 427–434. doi:10.1001/archdermatol.2008.609. ISSN   0003-987X. PMC   2735055 . PMID   19380664.
  22. "Bob Marley Shouldn't Have Died from Melanoma". Skin Cancer Foundation. 2016-02-06. Archived from the original on 2019-07-27. Retrieved 2016-10-11.

Further reading