Acral Lentiginous Melanoma is a subtype of melanoma that I encounter in both my The Woodlands dermatology and Conroe dermatology offices. Acral Lentiginous Melanoma is the most common subtype affecting darker skinned patients and Asians and occurs at sites such as the hands, feet and nail unit. The thumb and great toe are the most common areas affected. The prognosis of Acral Lentiginous Melanoma is very poor since these cancers are usually detected late in the course of the disease after the radial phase has progressed to the invasive vertical phase. Many patients do not examine the soles of the feet and between the toe webs leading to this late detection. Most nail unit Acral Lentiginous Melanomas arise in the nail matrix underlying the proximal nail fold of skin prior to the emergence of the nail plate. The appearance of a melanoma arising in the nail matrix is as if a black marking pen drew a vertical line from the base of the nail plate to the distal end. In many cases, the Hutchinson’s sign occurs in which pigmentation extends onto the skin of the proximal nail fold. Treatment of Acral Lentiginous Melanoma is wide excision with or without a sentinel lymph node biopsy and lifelong surveillance by a board certified dermatologist.
