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Case Reports
. 2020 Jun 3;12(6):e8424.
doi: 10.7759/cureus.8424.

Acral Lentiginous Melanoma: A Rare Variant With Unique Diagnostic Challenges

Brett C Brazen  1 , Taylor Gray  2 , Maheera Farsi  3 , Richard Miller  4
Affiliations
Case Reports

Acral Lentiginous Melanoma: A Rare Variant With Unique Diagnostic Challenges

Brett C Brazen et al. Cureus. .

Abstract

Acral lentiginous melanoma (ALM), named for its location and histological growth pattern, is a rare variant of melanoma. ALM presents on palms, soles, or in association with the nail unit. While ALM accounts for approximately 5% of melanomas diagnosed each year, it is the most commonly diagnosed subtype of melanoma in non-Caucasian patients, and it is most likely to be diagnosed in the seventh decade of life. We present a case of a 72-year-old, Fitzpatrick skin type (FST) 5 female who presented to our clinic with a chief complaint of a slowly enlarging dark brown patch with a variation of pigment changes that had been present for 10 years on her right plantar surface. Biopsy obtained for hematoxylin and eosin (H&E) revealed malignant melanoma in situ, acral lentiginous type. Here, we will discuss the unique pathogenesis of ALM, as well as, its characteristic clinical and histological findings. Furthermore, this case underscores the importance of physician and patient education to raise awareness of this rare type of melanoma, specifically in patients with skin of color in hopes of decreasing time to diagnosis and improving prognosis.

Keywords: cutaneous oncology; dermatology; dermatopathology; genodermatoses; malignant melanoma.

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Conflict of interest statement

This research was supported (in whole or in part) by HCA and/or an HCA affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA or any of its affiliated entities.

Figures

Figure 1
Figure 1. A 3.0 cm x 1.5 cm well-demarcated, brown to black patch with two adjacent smaller brown to black patches with scalloped borders on the right plantar surface.
Figure 2
Figure 2. Extensive proliferation of malignant melanocytes in a nested array (4x).
Figure 3
Figure 3. Extensive proliferation of malignant melanocytes in a confluent (left arrow), and pagetoid array (right arrow) (10x).
Figure 4
Figure 4. Extensive proliferation of malignant melanocytes in a pagetoid array (10x).
Figure 5
Figure 5. SOX10 immunohistochemical stain demonstrating extensive proliferation of melanocytes within the epidermis (10x).
See this image and copyright information in PMC

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