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Acral Lentiginous Melanoma: A Review and Diagnostic and Surgical Considerations for the Mohs and Dermatologic Surgeon
Jordan Phillipps1, Naiara Barbosa1, Catherine Degesys1
1Department of Dermatology, Mayo Clinic, Jacksonville, Florida.
Background:
Acral lentiginous melanoma (ALM) is a biologically distinct, inherently aggressive, and understudied melanoma subtype without a unified surgical approach.
Objective:
To provide an updated review of ALM and offer practical, surgeon-focused guidance on diagnosis, biopsy, margin-controlled excision, and Mohs micrographic surgery (MMS)-based management of ALM.
Methods Materials:
A PubMed/MEDLINE search of ALM, with an emphasis on articles published after 2015.
Results:
ALM demonstrates inherent biological aggressiveness characterized by extensive subclinical spread, delayed diagnosis, and higher stage-adjusted recurrence compared with nonacral cutaneous melanomas. Anatomic constraints additionally necessitate specialized surgical approaches, although current management is extrapolated from nonacral melanoma data. Retrospective data support MMS and margin-controlled excision and tissue preservation in ALM, with the benefit of digit-sparing surgery and functional preservation. No randomized trials have included ALM, highlighting a key evidence gap.
Conclusion:
Margin-controlled approaches such as MMS may improve local control and tissue preservation in select ALM patients. Prospective ALM-specific research and standardized diagnostic and surgical protocols are strongly needed.
