Melanoma acrolentiginous C43.7 / C43.7

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Acral lentiginous melanoma; Acral lentiginous melanoma (e); Acral melanoma; Acrolentiginous malignant melanoma; Acrolentiginous melanoma; acrolentiginous melanoma (e); ALM; Finger melanoma; Foot melanoma; Hand melanoma; Melanoma of the fingers; Melanoma of the foot; Melanoma of the hand; Melanoma of the toes; plantar/palmar melanoma

Definition
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On the palms of the hands and soles of the feet, on fingers, toes and under the nails, localized growth type of malignant melanoma. The acral lentiginous malignant melanoma grows horizontally for a long time, often unnoticed or unrecognized, before a vertical change in growth makes it recognizable as a tumor node. Often the advanced melanoma of the acrolentine type lacks the "signal colour black" so that the node appears "inconspicuously" reddish or yellow-reddish. This is especially true for ulcerated acrolentiginous melanomas.

Occurrence/Epidemiology
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ALM accounts for about 4-5% of the total melanoma incidence, and subungual ALM for 1-3%. From this, incidence rates between 0.2-0.3/100,000 inhabitants can be calculated.

Etiopathogenesis
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Among acrolentiginous melanomas, the group of subungual/interdigital melanomas is the most diversified, with oncogenic mutations in the genes PIK3CA, STK11, EGFR, FGFR3 and PTPN11. They show BRAF mutations less frequently and have a higher frequency of copy variations (67%!) especially in CDK4 and cyclin-D1. (Haugh et al. 2018)

Manifestation
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Older people > 60 years. No gender specificity.

Clinical features
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Differently large, brown to black, blotchy or plaque-like skin changes.

Horizontal-radial, later circumscribed or diffuse vertical growth with infiltration of the dermis and increasing contouring, nodular, scaly elevations. Superficial erosions, ulcerations.

The clinical maximum variant is a weeping, bleeding tumour node surrounded by a thickened corneal layer.

Other ALM grow for years in a horizontal direction, remain clinically as flat plaques, almost at the skin level, usually with regressions, so that anular or circulatory structures can develop which no longer have structural commonality with the primary image. Complete regressions are also possible.

  • The subungual malignant melanoma shows an independent clinical morphology. Although it is a subtype of acrolentiginous malignant melanoma, it is treated independently and as a subungual malignant melanoma.
  • Reflected light microscopy: Initially striped, irregular pigmentation, orienting along the inguinal lines, brown, blurred spots in the tumor surroundings.

Histology
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Numerous atypical melanocytes that penetrate the epidermis in a nest and penetrate deep into the skin. Acrolentiginous melanomas show a clear overexpression of c-kit.

Therapy
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Progression/forecast
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  • The prognostic indicators are far from being as accurate as for malignant melanomas of other localizations, since the Breslow index for acral localized melanomas often gives imprecise values or cannot be assessed at all.
  • In follow-up examinations of metastasized thin melanomas (tumor thickness < 0.75 mm s. Breslow index ), ALM and LMM were significantly overrepresented.
  • The acral lentiginous melanomas tend to superficial horizontal growth initially and over the long term. Since they are often diagnosed clinically late, they are often only diagnosed and treated at an advanced stage.
  • The expression of c-Kit plays an important role in the therapy of metastatic acrolentiginous melanoma (see below Imatinib)

Literature
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  1. Baccard M et al (2009) Acrolentiginous melanoma. Ann Dermatol Venereol 136:389-390

  2. Baumert J et al (2009) Time trends in tumour thickness vary in subgroups: analysis of 6475 patients by age, tumour site and melanoma subtype. Melanoma Res 19:24-30

  3. Fallowfield ME et al (1994) Melanocytic lesions of the palm and sole. Histopathology 24: 463-467
  4. Gutman M et al (1985) Acral (volar-subungual) melanoma. Br J Surg 72: 610-613
  5. Haugh AM et al (2018) Distinct Patterns of Acral Melanoma Based on Site and Relative Sun Exposure.
    J Invest Dermatol 138:384-393.
  6. Margolis RJ et al (1989) Comparison of acral nevomelanocytic proliferations in Japanese and whites. J Invest Dermatol. 92(5 Suppl): S222-226
  7. Mishima Y, Nakanishi T (1985) Acral lentiginous melanoma and its precursor-heterogeneity of palmo-plantar melanomas. Pathology 17: 258-265
  8. Schmidt-Wendtner et al (2003) Disease progression in patients with cutaneous melanomas (tumor thickness &lt; 0.75 mm): clinical and epidemiological data from the tumor center Munich 1977-1998 Br J Dermatol 149: 788-793
  9. Schoenewolf NL et al (2012) Sinonasal, genital and acrolentiginous melanomas show distinct characteristics of KIT expression and mutations. Eur J Cancer 48:1842-1852

  10. Shaw JH, Koea JB (1988) Acral (volar-subungual) melanoma in Auckland, New Zealand. Br J Surg 75: 69-72
  11. Tuominen L, Strengell L (1992) Melanoma of palms, soles, and nail-beds. Scand J Plast Reconstr Surg Hand Surg 26: 287-292

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020