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Takai S, Arai E, Shojiguchi N, Nakamura Y, Momose S, Fukuda T, Ishizawa K, Ogata D, Tsunemi Y, Nakamura K, Tsuchida T. Application of fluorescence in situ hybridization in distinguishing acral melanoma in situ from acral junctional melanocytic nevus on the volar skin in Japanese patients. J Dermatol 2022; 50:637-645. [PMID: 36539950 DOI: 10.1111/1346-8138.16681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Four-colored fluorescence in situ hybridization (FISH) is an ancillary diagnostic tool for melanoma. However, most studies that have investigated the usefulness of FISH primarily focused on advanced melanomas. The aim of the current study was to evaluate the effectiveness of FISH in distinguishing acral melanoma (AM) in situ from benign acral junctional nevus (AJN), two types of lesions that are difficult to differentiate via traditional clinical means. The authors investigated the usefulness of FISH in 91 acral melanocytic lesions, including 50 lesions with diagnostic discrepancies between dermoscopic and pathologic approaches or difficulty diagnosing between AM in situ and AJN, on the volar skin of Japanese patients. The authors classified the lesions based on the diagnosis of dermatologists and pathologists into four groups: (I) lesions with a unanimous diagnosis by dermatologists and pathologists as AM in situ or AJN (n = 41); (II) lesions with a unanimous diagnosis by dermatologists only as AM in situ or AJN (n = 21); (III) lesions with a unanimous diagnosis by pathologists only as AM in situ or AJN (n = 15); and (IV) all other lesions (n = 14). The dermatologists diagnosed the lesions by clinical and dermoscopic photographs alone, while the pathologists diagnosed the lesions by microscopy of hematoxylin and eosin-stained slides alone. In group I (AM in situ [n = 20] and AJN [n = 21]), four-colored FISH demonstrated 90% sensitivity and 81% specificity in distinguishing AM in situ from AJN. There was a significant correlation between the FISH results and the unanimous diagnoses by pathologists alone (p = 0.03) in group III. However, FISH results were not significantly correlated with the unanimous diagnoses by dermatologists alone (p = 0.33) in group II. In conclusion, the four-colored FISH probe kit was useful in distinguishing between AM in situ and AJN and may be an ancillary method when pathologists who are not experts of dermatopathology diagnose melanocytic lesions.
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Affiliation(s)
- Sayaka Takai
- Department of Dermatology, Saitama Medical University, Saitama, Japan.,Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Eiichi Arai
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naoko Shojiguchi
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shuji Momose
- Department of Pathology, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoo Fukuda
- Department of Dermatology, Saitama Medical University Saitama Medical Center, Saitama, Japan
| | - Keisuke Ishizawa
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Dai Ogata
- Department of Dermatology, Saitama Medical University, Saitama, Japan.,Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, Saitama, Japan
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Ahuja G, Kim JH, Tran JF, Nnorom S, Ali A, Ibrahim M, Okoye GA, Shokrani B, Dunmore-Griffith J, Geter K, Frederick WAI, Wilson L. Metastatic Acral lentiginous melanoma: A case report and review. J Natl Med Assoc 2022; 114:290-294. [PMID: 35221075 DOI: 10.1016/j.jnma.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 12/01/2022]
Abstract
Of the four subtypes of cutaneous melanoma, acral lentiginous melanoma (ALM) is atypical in its presentation. ALM is a rare melanoma subtype that presents on the volar surfaces of the hand and foot. The difficulty of making an early diagnosis of ALM is highlighted by the case seen in our institution. The dire prognosis associated with ALM is postulated to be not only related to its destructive nature, but also due to a lack of patient awareness and vigilance, inadequate physician awareness, and disparity in healthcare access. We present this as a unique account of an ALM lesion in a 76 year old African-American male presenting originally in the left foot that went misdiagnosed for several years. The original lesion was considered to be an ulcerating left great toe lesion with signs typical of osteomyelitis. These clinical findings were corroborated by radiological x-ray evidence. Upon amputation and biopsy for suspected worsening osteomyelitis five years later, the pathological diagnosis of melanoma was finally made.
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Affiliation(s)
- Geeta Ahuja
- Howard University College of Medicine, Washington, DC, United States.
| | - Jae Ho Kim
- Howard University College of Medicine, Washington, DC, United States
| | | | - Siobhan Nnorom
- Department of Surgical Outcomes, Howard University Hospital, Washington, DC, United States
| | - Ahmed Ali
- Department of Hematology and Oncology, Howard University Hospital, Washington, DC, United States
| | - Mohammed Ibrahim
- Department of Internal Medicine, Howard University Hospital, Washington, DC, United States
| | - Ginette A Okoye
- Department of Dermatology, Howard University Hospital, Washington, DC, United States
| | - Babak Shokrani
- Department of Pathology, Howard University Hospital, Washington, DC, United States
| | | | - Kirk Geter
- Department of Surgical Outcomes, Howard University Hospital, Washington, DC, United States
| | - Wayne A I Frederick
- Howard University College of Medicine, Washington, DC, United States; Division of Surgical Oncology, Dept. of Surgery, Howard University Hospital, Washington, DC, United States
| | - Lori Wilson
- Howard University College of Medicine, Washington, DC, United States; Division of Surgical Oncology, Dept. of Surgery, Howard University Hospital, Washington, DC, United States
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Acral lentiginous melanoma in situ: dermoscopic features and management strategy. Sci Rep 2020; 10:20503. [PMID: 33239715 PMCID: PMC7688656 DOI: 10.1038/s41598-020-77425-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/06/2020] [Indexed: 11/08/2022] Open
Abstract
Diagnosis of acral lentiginous melanoma in situ (ALMIS) is challenging. However, data regarding ALMIS are limited in the literature. The aim of this study was to investigate the clinical and dermoscopic features of ALMIS on palmoplantar surfaces. Patients with ALMIS and available dermoscopic images were retrospectively reviewed at our institution between January 2013 and February 2020. Clinical and dermoscopic features were analysed and compared between small (< 15 mm) and large (≥ 15 mm) ALMIS. Twenty-one patients with ALMIS were included in this study. Mean patient age was 58.5 (range 39-76) years; most lesions were located on the sole (90.5%). The mean maximal diameter was 19.9 ± 13.7 mm (mean ± standard deviation). Statistical analysis of dermoscopic features revealed that parallel ridge patterns (54.5% vs. 100%, P = 0.035), irregular diffuse pigmentation (27.3% vs. 100%, P = 0.001) and grey colour (18.2% vs. 90%, P = 0.002) were significantly less frequent in small lesions than in large lesions. We have also illustrated two unique cases of small ALMIS; their evolution and follow-up dermoscopic examination are provided. In conclusion, this study described detailed dermoscopic findings of ALMIS. Based on the present study and a review of the literature, we proposed a dermoscopic algorithm for the diagnosis of ALMIS.
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Darmawan CC, Jo G, Montenegro SE, Kwak Y, Cheol L, Cho KH, Mun JH. Early detection of acral melanoma: A review of clinical, dermoscopic, histopathologic, and molecular characteristics. J Am Acad Dermatol 2019; 81:805-812. [PMID: 30731177 DOI: 10.1016/j.jaad.2019.01.081] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
Acral lentiginous melanoma is a distinct subtype of melanoma on acral skin. Patient presentation at later stages and delayed diagnosis by physicians contribute to a worse associated prognosis and survival rate. Despite our progress in understanding the key features of this disease, the diagnosis of early-stage acral melanoma is still challenging. It is essential to integrate clinical, dermoscopic, and histologic findings in the diagnosis of acral lentiginous melanoma. In addition, molecular studies can be helpful. In this review, we have summarized our current understanding of this disease entity from articles that were published between 1969 and 2018. We have outlined clinical and dermoscopic features as well as pathologic and molecular findings regarding acral melanoma and have presented an algorithm for diagnosis. Understanding and integrating these characteristics may assist clinicians in the early detection of acral melanomas.
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Affiliation(s)
- Claudia C Darmawan
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Gwanghyun Jo
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Sara E Montenegro
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Lee Cheol
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Kwang Hyun Cho
- Department of Dermatology, Mediplex Sejong Hospital, Incheon, Korea
| | - Je-Ho Mun
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea.
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Abstract
OPINION STATEMENT Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Criscito MC, Stein JA. Improving the diagnosis and treatment of acral melanocytic lesions. Melanoma Manag 2017; 4:113-123. [PMID: 30190914 DOI: 10.2217/mmt-2016-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/16/2016] [Indexed: 01/15/2023] Open
Abstract
Melanocytic lesions of acral sites are common, with an estimated prevalence of 28-36% in the USA. While the majority of these lesions are benign, differentiation from acral melanoma (AM) is often challenging. AM is a unique subtype of melanoma, with distinct molecular characteristics that are thought to contribute to its high rate of locoregional recurrence and worse prognosis. The advent of dermoscopy has since improved the diagnostic accuracy of AM, resulting in earlier detection and arguably improved survival. Additionally, the identification of unique genomic amplifications in AM invites the potential for future AM-specific targeted therapies. Herein, we discuss the importance of dermoscopy in the diagnosis of acral melanocytic lesions and review the treatment strategies for AM.
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Affiliation(s)
- Maressa C Criscito
- The Ronald O Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Jennifer A Stein
- The Ronald O Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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Tognetti L, Fimiani M, Rubegni P. Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine. Dermatol Pract Concept 2015; 5:79-81. [PMID: 26114058 PMCID: PMC4462905 DOI: 10.5826/dpc.0502a14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/09/2015] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III–VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV–V and palmar as well as plantar involvement.
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Affiliation(s)
- Linda Tognetti
- Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena, Siena, Italy
| | - Michele Fimiani
- Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena, Siena, Italy
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Kim JY, Hwang EJ, Choi M, Jo SJ, Cho KH. Recurrent acral lentiginous melanoma in situ suggesting the field cell theory. Ann Dermatol 2014; 26:779-81. [PMID: 25473243 PMCID: PMC4252688 DOI: 10.5021/ad.2014.26.6.779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/20/2013] [Accepted: 12/11/2013] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jin Yong Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Eun Jung Hwang
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Mira Choi
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kwang Hyun Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea. ; Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
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Fracaroli TS, Lavorato FG, Maceira JP, Barcaui C. Parallel ridge pattern on dermoscopy: observation in non-melanoma cases. An Bras Dermatol 2014; 88:646-8. [PMID: 24068145 PMCID: PMC3760949 DOI: 10.1590/abd1806-4841.20132058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 09/24/2012] [Indexed: 11/21/2022] Open
Abstract
The acral melanoma is the most prevalent type of melanoma in the non-Caucasian
population, and dermoscopy is a useful tool for earlier diagnosis and differentiation
from benign lesions. The dermoscopic pattern often associated with melanoma on the
volar skin is the parallel ridge, with 99% specificity according to the literature.
However, this pattern can also occur in several benign acral lesions, so it is
important to make a good interpretation of this pattern, along with the clinical
history and evolution.
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Oh TS, Bae EJ, Ro KW, Seo SH, Son SW, Kim IH. Acral Lentiginous Melanoma Developing during Long-standing Atypical Melanosis: Usefulness of Dermoscopy for Detection of Early Acral Melanoma. Ann Dermatol 2011; 23:400-4. [PMID: 21909219 PMCID: PMC3162278 DOI: 10.5021/ad.2011.23.3.400] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 08/18/2010] [Accepted: 08/27/2010] [Indexed: 11/10/2022] Open
Abstract
Clinical guidelines suggest that suspicious pigmented lesions of the plantar or palmar area require biopsy for early detection of acral melanoma. We present here a case of acral lentiginous melanoma in which various melanocytic atypia was observed at each biopsy site, including focal melanocytic proliferation. We suggest that this atypical melanosis is part of a contiguous phase of invasive tumor growth, which is known as the very early stage of melanoma in situ. In addition, noninvasive dermoscopy has been effective for the early discovery of hidden lesions of acral melanoma.
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Affiliation(s)
- Tae Seok Oh
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
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Jin L, Arai E, Anzai S, Kimura T, Tsuchida T, Nagata K, Shimizu M. Reassessment of histopathology and dermoscopy findings in 145 Japanese cases of melanocytic nevus of the sole: toward a pathological diagnosis of early-stage malignant melanoma in situ. Pathol Int 2010; 60:65-70. [PMID: 20398189 DOI: 10.1111/j.1440-1827.2009.02483.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recently, dermoscopic visualization has been improved, allowing for the identification of malignant melanoma (MM) of the sole in situ. When the parallel ridge pattern is evident on dermoscopy, the proliferation of solitarily arranged melanocytes in the crista profunda intermedia should be examined histologically, since this may be a clue to the early diagnosis of MM in situ. We reviewed 145 Japanese cases of melanocytic nevus on the sole, and investigated several useful histological features for the diagnosis of MM in situ using a recent proposal as well as several standard histological criteria of MM in situ. Five cases were considered to be an early-stage MM in situ out of 145 cases previously diagnosed as melanocytic nevi of the sole. These cases showed several specific features, including solitarily arranged melanocytes or melanocyte nests comprising fewer than four cells. Our findings indicate that early-stage MM of the sole in situ can be diagnosed by using new dermoscopy-related histological findings. They are (i) irregular distribution of solitary melanocytes at the crista profunda intermedia with or without small nests (up to three melanocytes) on the slope of rete ridges; and (ii) larger melanocytes with a halo around the nucleus.
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Affiliation(s)
- Ling Jin
- Department of Pathology, Saitama Medical University, Saitama International Medical Center, Iruma-gun, Saitama, Japan
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Transverse-section Histology for Parallel-Ridge Pattern. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Acral lentiginous melanoma of the foot is a relatively rare but often very aggressive variant of melanoma. More commonly identified in patients with darker skin, diagnosis of the lesions is often delayed because the area is not routinely examined by patients or primary care physicians. In addition, these lesions often mimic other entities, including vascular lesions and infections. Greater awareness of this entity and performing appropriate biopsies will result in more timely diagnoses and improved survival.
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Affiliation(s)
- Douglas Albreski
- Department of Dermatology, MC 6230, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
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