What should you know about acral melanoma dermoscopy?

Acral skin has ridges and furrows that create fingerprint-like lines. With a dermatoscope, a clinician can see whether pigment follows these structures and whether colour and shape are evenly organised. Pigment concentrated along the ridges, irregular blotches, several colours, asymmetry or a disordered pattern can raise concern for acral melanoma. Benign moles more often show organised patterns along the furrows, although patterns can overlap.

The clinician interprets the whole lesion rather than relying on a single feature. They also consider where it is, whether it has changed, its appearance without magnification and whether trauma, bleeding under the skin, a wart or another condition could explain it. Nail lesions require assessment of the nail plate and nearby skin because their patterns differ from those on palms and soles.

Arrange a skin assessment for a new or changing dark mark on a palm, sole, finger, toe or around a nail, especially if it looks uneven or has no clear explanation. Do not cut, burn or treat the area yourself. Before the visit, note when you first saw it and any change in colour, width, shape, surface or symptoms. A clear photograph can help document change, but it does not replace examination.

If dermoscopy is concerning or the diagnosis remains uncertain, the dermatologist may recommend a biopsy. The biopsy site and technique should be chosen carefully so the laboratory receives tissue from the most informative area. Dermoscopy guides that decision; examination alone does not provide the tissue diagnosis used to confirm or exclude melanoma.

Book a prompt dermatology appointment if a mark is enlarging, developing uneven borders or colours, becoming raised, breaking down, bleeding without an obvious injury or failing to heal. A dark nail band that is widening, becoming irregular or spreading pigment onto the skin beside the nail also deserves timely assessment. These changes do not establish melanoma, but they should not be watched indefinitely without clinical review.

Seek urgent medical care for bleeding that does not stop with firm pressure or for signs of infection such as spreading redness, warmth, swelling, pus or fever. Those problems need attention because of the bleeding or infection itself, regardless of the cause of the original mark.

You may want to ask which dermoscopic features are reassuring or concerning, whether comparison photographs would add useful information, and whether biopsy is preferable to monitoring. If a biopsy is advised, ask which part will be sampled, how the procedure could affect walking, hand use or the nail, when to expect the pathology result, and who will explain the next step.