Acral Lentiginous Melanoma: A Case Control Study and Guidelines Update

Abstract

Background. Malignant melanoma incidence is increasing dramatically. We report herein a case of the rarest acral lentiginous type. Case Report. A 58-year-old man presented with a melanoma resembling lesion over the sole of his right foot, measuring 15–20 mm in diameter. An excisional biopsy with a narrow (2 mm) margin of surrounding skin was obtained. Histological findings were consistent with a diagnosis of acral lentiginous melanoma. Sentinel lymph node biopsy was also performed and micrometastases were not identified in frozen-section examination. According to the AJCC system, the tumor stage was IB (T2aN0M0). A wide local excision of the biopsy scar with a margin of 2 cm was performed. A split-thickness thick skin graft was used to reconstruct the excisional defect. During an 18-month followup, no local or distant recurrence has been observed. This paper aims to extract an updated rational approach to the management of this disease out of an enormous body of knowledge.

Acral melanoma of the foot: a study of 9 cases and guidelines update

“…Le MM se divise en 4 types histologiques (selon la classification de l'OMS 2006) rapportés ici par ordre de fréquence décroissante: le mélanome à extension superficielle (SSM), le mélanome nodulaire(NM), le mélanome lentigo malin(LMM) et le mélanome acrolentigineux(ALM) [5,6].…”

“…Le mélanome acrolentigineux (ALM) ou mélanome acral (MA) touche la peau palmo-plantaire et sous-unguéale; Reed fût le premier à le décrire en 1976 comme type de MM [6].…”

“…Il reste le type le plus décrit chez les sujets à peau pigmentée; en Afrique [1] et en Asie [8][9][10][11][12][13]. Chez le caucasien, le mélanome acral est rare [3,6].…”

Management of Acral Lentiginous Melanoma

“…One of the problems with SLNB of lower extremities is the presence of pelvic SLNs. Kaoutzanis et al showed 11 of 82 cases with tumour on lower extremities had SLNs on the pelvic region and underwent SLNB [60]. They also showed that 19 of 82 cases (24%) had positive SLNs and all the positive SLNs were located in the inguinal region.…”

Bilateral Seqential Acral Lentiginous Melanoma of the Sole.

“…3 According to some of the reports, ALM on the sole has a worse prognosis than other areas of the body, however the tumor thickness has a greater impact on prognosis than anatomical location. 4 The prognosis of lesions on the sole may be worse due to the fact that they may be noticed lately.…”