Acral cutaneous melanoma in caucasians: clinical features, histopathology and prognosis in 112 patients

Background Acral lentiginous melanoma (ALM) is the fourth distinct variant of cutaneous melanoma. The histological diagnosis and prognosis of ALM are still controversial.  Objectives To review the features of a large series of patients with ALM, and confirm the validity of the histological criteria for this type of melanoma.  Methods A collection of 2642 patients with cutaneous melanoma was recorded during the period 1986–97, among these 187 were located on acral sites. Histological specimens were reviewed in 112 acral melanomas; the following study is based on this subgroup.  Results Histological examination revealed acral lentiginous melanomas predominantly in palmoplantar and subungual locations (60%), while superficial spreading melanomas (SSM) were found mainly on the dorsal aspects of hands and feet (30%). Nodular melanomas (NM) (9%) occurred in all acral sites. The histological re‐examination confirmed the characteristics of ALM as described by Reed in 1976. With increasing tumour thickness nesting of tumour cells and upward migration to the cornified layer was similarly observed. The 5‐year survival rate for patients with primary acral melanoma without recognizable metastasis was 82%. ALM differed significantly in survival from SSM (P = 0·001) and lentigo maligna melanoma (P < 0·001), but survival rates were similar to NM (P = 0·9).  Conclusions ALM, as diagnosed by current histological criteria, occur on the palms, soles and subungual sites, and have a poor prognosis.