Dermoscopy facilitates early diagnosis of acral lentiginous melanomas and reduces unnecessary biopsies

"Dermoscopy use and an understanding of managing acral lesions may limit the number of biopsies performed on the acral skin, reduce the time to diagnosis, and facilitate early ALM detection," the researchers wrote in their study.

Acral lentiginous melanoma is a rare skin cancer type. It begins when melanocytes in the skin grow out of control and lead to tumour formation. Melanocytes are the cells responsible for making melanin, the pigment that determines the skin's colour. The main sign of ALM is a brown or black discolouration that appears on the palm of the hand or the sole of the foot. It may resemble a strain or bruise, but over time it grows in size.

Survival outcomes in acral lentiginous melanoma are worse than for cutaneous melanoma. Diagnostic delays may contribute to worse outcomes in ALM, including advanced-stage disease at initial presentation. Acral lentiginous melanoma, particularly in its early stages, may be difficult to discern from benign pigmented acral lesions. Therefore, Jenne P. Ingrassia, New York University Grossman School of Medicine, New York, New York, and colleagues aimed to provide a comprehensive review of the diagnosis and management of acral pigmented lesions.

For this purpose, the researchers performed a literature review. The outcomes included were the dermoscopic and clinical features and management framework and considerations for acral melanosis, acquired and congenital melanocytic nevi, ALM, and nonmelanocytic pigmented lesions. The review primarily included original research studies.

The key findings of the study were as follows:

• The use of dermoscopy, such as the 3-step algorithm and blotch (irregular), ridge pattern (parallel), asymmetry of colours, asymmetry of structures, furrow pattern (parallel), fibrillar pattern (BRAAFF) checklist, increases the diagnostic accuracy of acral pigmented lesions with high specificity and sensitivity.
• Short-term digital dermoscopic surveillance can be used to manage acral lesions, and histopathology should be collected when there is a concern for ALM.

"The comprehensive review explores several management and diagnostic approaches for acral pigmented lesions, emphasizing the role of dermoscopy," the researchers concluded.

Reference:

Ingrassia, Jenne P. BA*,†; Stein, Jennifer A. MD, PhD*; Levine, Amanda MD*; Liebman, Tracey N. MD*. Diagnosis and Management of Acral Pigmented Lesions. Dermatologic Surgery ():10.1097/DSS.0000000000003891, August 8, 2023. | DOI: 10.1097/DSS.0000000000003891