Management of Aggressive Acral Melanoma in a Pregnant Patient

Acral melanoma is a rare and aggressive subtype of melanoma that arises on non-sun-exposed areas such as the soles, palms, and nail beds. It is often diagnosed at advanced stages and carries a poor prognosis. We present the case of a 28-year-old pregnant woman at 17 weeks gestation who developed a rapidly enlarging, ulcerated mass on the plantar aspect of her left foot. Biopsies confirmed acral lentiginous melanoma with extensive metastatic spread to the bones, liver, spleen, and lymph nodes. Immunohistochemical analysis was positive for MART-1, preferentially expressed antigen in melanoma (PRAME), and SOX10. After multidisciplinary counseling, the patient elected to terminate her pregnancy to initiate systemic immunotherapy. Despite treatment, her disease progressed rapidly, and she passed away shortly after the initiation of therapy. This case highlights the complexities of diagnosing and managing advanced melanoma in pregnancy and underscores the importance of the early recognition of atypical acral lesions, the limitations of treatment options during gestation, and the ethical challenges in balancing maternal and fetal health.