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Cancers 2010, 2(2), 642-652; doi:10.3390/cancers2020642

Acral Lentiginous Melanoma in Situ: A Diagnostic and Management Challenge

Department of Dermatology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
Author to whom correspondence should be addressed.
Received: 4 March 2010 / Revised: 8 April 2010 / Accepted: 19 April 2010 / Published: 20 April 2010
(This article belongs to the Special Issue Current Concepts in the Diagnosis and Treatment of Cutaneous Melanoma)
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Early stage recognition of acral lentiginous melanoma (ALM) is important for a better prognosis, but in-depth understanding and proper management of ALM in situ is complicated, because there are only a few reports, probably due to its rarity and diagnostic difficulty. We have reviewed our experience with seven patients who were diagnosed as having ALM in situ and discuss how to accurately diagnose and properly manage these rare lesions. Clinically the lesions showed black to brown discoloration of the nail with Hutchinson’s sign and hyperpigmented macules on the heel with color variegation. All the lesions showed a diffuse lentiginous pattern of melanocytic proliferation with variable level of atypism along the dermoepidermal junction. Dermoscopic findings were available in three and revealed parallel ridge patterns. Confrontation of clinical and histopathologic findings was observed in three, and the lesions were not recognized or diagnosed as ALM in situ in the first place. Excision of the primary lesion with variable operative margin was done as an initial treatment. Recurrence was observed in three patients and one developed invasive ALM and lymph node metastasis. Integration of all available information concerning the clinical presentation, histopathology, and dermoscopic findings is very important and can lead to the best classification for correct diagnosis. Lack of knowledge upon clinical course and optimal margin to control ALM in situ provokes the need for further studies with longer follow up and larger number of cases.
Keywords: acral lentiginous melanoma; acral lentiginous melanoma in situ; acral melanoma in situ acral lentiginous melanoma; acral lentiginous melanoma in situ; acral melanoma in situ
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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Park, H.S.; Cho, K.H. Acral Lentiginous Melanoma in Situ: A Diagnostic and Management Challenge. Cancers 2010, 2, 642-652.

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