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A Journal on Dermatology and Sexually Transmitted Diseases

Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2018 Mar 06

DOI: 10.23736/S0392-0488.18.05791-7


language: English

Acral melanoma: correlating the clinical presentation to the mutational status

Giulia M. RAVAIOLI , Emi DIKA, Martina LAMBERTINI, Marco A. CHESSA, Pier A. FANTI, Annalisa PATRIZI

Dermatology Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy


Acral lentiginous melanoma (ALM) is the most common type of malignant melanoma (MM) in Asians, Afro-Americans and Middle-Easterns. It represents 1.5-10% of all MM cases, being the most common histological type of MM arising on palms, soles and nail apparatus, which is more generically defined as acral MM. To date no risk factors have been officially established, however a history of trauma may be involved in the pathogenesis of acral MM. This shows heterogeneous clinical features and frequently presents with advanced stage and aggressive behaviour, often as a result of misdiagnosis or delayed identification. Dermoscopy is helpful for an early diagnosis of ALM: the most characteristic dermoscopic patterns are the parallel ridge and the irregular diffuse pigmentation. On histopathology ALM displays a lentiginous growth pattern, with melanocytes arranged as solitary units along the basilar epidermis, without notable pagetoid growth in the early stage. Not all acral MMs present a lentiginous pattern: superficial spreading melanoma (SSM) and nodular melanoma (NM) patterns are possible, too. Novel studies investigating the biologic characteristics of acral MM reported variable results: the overall mutational rates ranged respectively between 8.5 and 23% for KIT, between 3.6 and 33.3% for BRAF and between 3 and 47% for NRAS in ALMs. Increasing attention has been recently given to other genes, such as telomerase reverse transcriptase (TERT), platelet-derived growth factor receptor alfa (PDGFRA) and cyclin D1 (CCND1). Larger molecular investigations urge to describe the molecular profile of acral MM, to allow the development of specific targeted therapies.

KEY WORDS: Melanoma - Genetics - Pathology - Dermoscopy

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Publication History

Article first published online: March 06, 2018
Manuscript accepted: February 22, 2018
Manuscript revised: February 12, 2018
Manuscript received: September 21, 2017

Cite this article as

Ravaioli GM, Dika E, Lambertini M, Chessa MA, Fanti PA, Patrizi A. Acral melanoma: correlating the clinical presentation to the mutational status. G Ital Dermatol Venereol 2018 Mar 06. DOI: 10.23736/S0392-0488.18.05791-7

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