What should you know about acral lentiginous malignant melanoma?

It can appear as an enlarging irregular patch, a changing spot on a sole or palm, or a pigmented band in a nail. Suspicious change should be examined promptly because visual inspection cannot confirm melanoma.

Acral refers to the palms, soles, fingers, toes and nail units. Lentiginous describes an early sideways growth pattern of abnormal pigment-producing cells. The term malignant melanoma indicates that those cells are cancerous and may invade deeper tissue.

Possible presentations include uneven brown or black pigmentation, mixed colours, an irregular edge, progressive enlargement, nail splitting or pigment extending onto nearby skin. Acral melanoma presents with such changes, but many marks in these locations are benign; the direction of concern runs from the diagnosed condition to its possible signs, not from a sign to a presumed diagnosis.

Arrange a dermatology review for a new or evolving acral mark. The clinician may use a dermatoscope and compare the pigment pattern with surrounding skin. If melanoma is suspected, a biopsy provides tissue for diagnosis and measures features that guide staging.

Surgical removal is the main treatment for a localised tumour, with the margin planned from the pathology findings. A sentinel lymph node biopsy may be discussed in some cases to check regional spread. More advanced disease can require imaging and systemic treatment such as immunotherapy, planned by a multidisciplinary cancer team.

Seek prompt assessment for a palm or sole mark that enlarges, changes colour or shape, bleeds, ulcerates or does not heal. A widening nail streak, a new streak in one nail, nail distortion, or pigment spreading beyond the nail onto adjacent skin also warrants review.

Do not wait for pain: melanoma may be painless. If a confirmed melanoma is followed by new persistent neurological symptoms, breathing difficulty, unexplained weakness or rapidly worsening illness, contact the cancer team urgently for assessment of possible spread or another serious cause.

Ask what the pathology shows about tumour depth and ulceration, whether further surgery or lymph-node assessment is advised, and whether scans are needed. Request a clear plan for wound care, skin and nail checks, surveillance visits, and symptoms that should bring the appointment forward.