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Table of ContentsView All

View All

Table of Contents

Types

Symptoms

Causes

Diagnosis

Treatment

Prognosis

Next in Acral Lentiginous Melanoma Guide

This article discusses the symptoms, causes, diagnosis, and treatment of ALM.

Verywell / Michela Buttignol

Types of Acral Lentiginous Melanoma

The two primary characteristics of ALM are:

Prevalence of ALMAcral lentiginous melanoma is the least common subtype of allmelonomas. It’s less common in White people (less than 10% of ALM cases),but it accounts for 70% of melanomas in Black people and 46% in Asian people.

Prevalence of ALM

Acral lentiginous melanoma is the least common subtype of allmelonomas. It’s less common in White people (less than 10% of ALM cases),but it accounts for 70% of melanomas in Black people and 46% in Asian people.

There are a number of characteristic changes in the feet, hands, and nail beds associated with ALM. These include:

Thecause of ALMis not clear.

There may be a genetic component associated with the development of this type of melanoma. One study found people who had ALM were more likely to have had another type of cancer or a family history of a cancer other than melanoma.

Sun exposure isn’t believed to be a cause, because this type of cancer appears on parts of the body that aren’t often exposed to as much UV (ultraviolet) rays from the sun.

For diagnosing melanoma lesions, the ABCDE system is often used to determine if any spots on the skin may be potentially cancerous.

ABCDE System for Melanoma LesionsThe ABCDE rule outlines the following characteristics of potentially cancerous skin lesions:Asymmetry: One half does not look the same as the other.Border irregularity: The spot has jagged or irregular edges.Color variegation: The pigment of the spot is not the same throughout and may have different colors.Diameter: The spot is larger than 6 millimeters across.Evolving or elevation: The spot or lesion changes in size, shape, and color over time, and it may start growing vertically (becoming raised).

ABCDE System for Melanoma Lesions

The ABCDE rule outlines the following characteristics of potentially cancerous skin lesions:Asymmetry: One half does not look the same as the other.Border irregularity: The spot has jagged or irregular edges.Color variegation: The pigment of the spot is not the same throughout and may have different colors.Diameter: The spot is larger than 6 millimeters across.Evolving or elevation: The spot or lesion changes in size, shape, and color over time, and it may start growing vertically (becoming raised).

The ABCDE rule outlines the following characteristics of potentially cancerous skin lesions:

Because of the challenges with correctly diagnosing ALM, providers may use a handheld device called adermascopeto closely examine any potential cancerous lesions. This tool allows the provider to see multiple parts of the skin that are not typically visible to the naked eye to assist with a diagnosis.

However, because of where the lesions are found on the body, misdiagnosis is common. For example, ALM lesions on the feet can be confused withplantar warts, ingrown toenails, blisters, calluses, benign (noncancerous) tumors, and ulceration.

Similarly, the characteristic sign of ALM in the nail bed is a brown or black line on the length of the nail. This type of line on the nail can be associated with trauma (such as having smashed a finger in a door) or even a fungal infection.

Being of a lower socioeconomic status, not having access to a dermatologist, not getting a full-body examination during primary care visits, and lacking information about ALM also are factors that contribute to the risk of misdiagnosis.

Acral lentiginous melanoma is highly treatable when diagnosed and treated early. Typical treatment is surgical removal of the lesion with the aim to remove the cancer, prevent it from coming back, and maintain the appearance of the skin.

However, if ALM is more advanced and has spread elsewhere in the body, additional treatments may be necessary. These may includechemotherapy,radiation therapy, andimmunotherapy.

What Is Acral Lentiginous Melanoma?

Survival rates are best for those with ALM when diagnosed at an early stage. However, because diagnosis is often challenging and delayed, people with advanced ALM have a poorer prognosis.

Factors that influence survival rates include the thickness of the lesion, ulceration (a break in the skin),mitotic rate(used to help find the stage of melanoma), and how far the cancer has spread in the body. Experiencing a recurrence of the lesion is 2 to 5 times more common than other types of melanoma.

Summary

Acral lentiginous melanoma is rare type of skin cancer. It primarily affects the hands, feet, and nail beds. It is more common in Black people and Asian people. Misdiagnosis can be common, but ALM can be treated successfully with surgery if diagnosed early.

A Word From Verywell

Because ALM can be challenging to diagnose, it’s important to be familiar with how your body looks so you can notice changes—like a new growth or mole—that are worth investigating. Identifying any potentially cancerous spots early with the help of a healthcare provider or dermatologist can increase the chances of early treatment and a positive prognosis. While a diagnosis of ALM can be scary, effective treatment is available when caught early.

8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.SEER modules: types of melanoma.Huang K, Fan J, Misra S.Acral lentiginous melanoma: incidence and survival in the united states, 2006-2015, an analysis of the seer registry.Journal of Surgical Research. 2020;251:329-339. doi:10.1016/j.jss.2020.02.010AIM at Melanoma Foundation.Acral lentiginous melanoma.Memorial Sloan Kettering Cancer Center.Acral letiginous melanoma.Csányi I, Houshmand N, Szűcs M, et al.Acral lentiginous melanoma: a single-centre retrospective review of four decades in East-Central Europe.Journal of the European Academy of Dermatology and Venereology. 2020;34(9):2004-2010. doi:10.1111/jdv16227Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, et al.Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease.Pigment Cell & Melanoma Research. 2021;34(1):59-71. doi:10.1111/pcmr.12885Ward WH, Lambreton F, Goel N, Yu JQ, Farma JM.Clinical presentation and staging of melanoma. In: Ward WH, Farma JM, eds.Cutaneous Melanoma: Etiology and Therapy. Codon Publications; 2017. doi:10.15586/codon.cutaneousmelanoma.2017.ch6Bristow IR, de Berker DA.Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit.J Foot Ankle Res. 2010;3(1):22. doi:10.1186/1757-1146-3-22

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Cancer Institute.SEER modules: types of melanoma.Huang K, Fan J, Misra S.Acral lentiginous melanoma: incidence and survival in the united states, 2006-2015, an analysis of the seer registry.Journal of Surgical Research. 2020;251:329-339. doi:10.1016/j.jss.2020.02.010AIM at Melanoma Foundation.Acral lentiginous melanoma.Memorial Sloan Kettering Cancer Center.Acral letiginous melanoma.Csányi I, Houshmand N, Szűcs M, et al.Acral lentiginous melanoma: a single-centre retrospective review of four decades in East-Central Europe.Journal of the European Academy of Dermatology and Venereology. 2020;34(9):2004-2010. doi:10.1111/jdv16227Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, et al.Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease.Pigment Cell & Melanoma Research. 2021;34(1):59-71. doi:10.1111/pcmr.12885Ward WH, Lambreton F, Goel N, Yu JQ, Farma JM.Clinical presentation and staging of melanoma. In: Ward WH, Farma JM, eds.Cutaneous Melanoma: Etiology and Therapy. Codon Publications; 2017. doi:10.15586/codon.cutaneousmelanoma.2017.ch6Bristow IR, de Berker DA.Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit.J Foot Ankle Res. 2010;3(1):22. doi:10.1186/1757-1146-3-22

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

National Cancer Institute.SEER modules: types of melanoma.Huang K, Fan J, Misra S.Acral lentiginous melanoma: incidence and survival in the united states, 2006-2015, an analysis of the seer registry.Journal of Surgical Research. 2020;251:329-339. doi:10.1016/j.jss.2020.02.010AIM at Melanoma Foundation.Acral lentiginous melanoma.Memorial Sloan Kettering Cancer Center.Acral letiginous melanoma.Csányi I, Houshmand N, Szűcs M, et al.Acral lentiginous melanoma: a single-centre retrospective review of four decades in East-Central Europe.Journal of the European Academy of Dermatology and Venereology. 2020;34(9):2004-2010. doi:10.1111/jdv16227Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, et al.Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease.Pigment Cell & Melanoma Research. 2021;34(1):59-71. doi:10.1111/pcmr.12885Ward WH, Lambreton F, Goel N, Yu JQ, Farma JM.Clinical presentation and staging of melanoma. In: Ward WH, Farma JM, eds.Cutaneous Melanoma: Etiology and Therapy. Codon Publications; 2017. doi:10.15586/codon.cutaneousmelanoma.2017.ch6Bristow IR, de Berker DA.Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit.J Foot Ankle Res. 2010;3(1):22. doi:10.1186/1757-1146-3-22

National Cancer Institute.SEER modules: types of melanoma.

Huang K, Fan J, Misra S.Acral lentiginous melanoma: incidence and survival in the united states, 2006-2015, an analysis of the seer registry.Journal of Surgical Research. 2020;251:329-339. doi:10.1016/j.jss.2020.02.010

AIM at Melanoma Foundation.Acral lentiginous melanoma.

Memorial Sloan Kettering Cancer Center.Acral letiginous melanoma.

Csányi I, Houshmand N, Szűcs M, et al.Acral lentiginous melanoma: a single-centre retrospective review of four decades in East-Central Europe.Journal of the European Academy of Dermatology and Venereology. 2020;34(9):2004-2010. doi:10.1111/jdv16227

Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, et al.Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease.Pigment Cell & Melanoma Research. 2021;34(1):59-71. doi:10.1111/pcmr.12885

Ward WH, Lambreton F, Goel N, Yu JQ, Farma JM.Clinical presentation and staging of melanoma. In: Ward WH, Farma JM, eds.Cutaneous Melanoma: Etiology and Therapy. Codon Publications; 2017. doi:10.15586/codon.cutaneousmelanoma.2017.ch6

Bristow IR, de Berker DA.Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit.J Foot Ankle Res. 2010;3(1):22. doi:10.1186/1757-1146-3-22

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