Acral lentiginous melanoma in situ: dermoscopic features and management strategy

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.

Figure 1

Clinical and dermoscopic features of acral lentiginous melanoma in situ (ALMIS): small versus large ALMIS. (A,B) The 12-mm ALMIS showed asymmetry, irregular dots and globules, and irregular fibrillar pattern. (C,D) The 31-mm ALMIS showed asymmetry, parallel ridge pattern, and irregular diffuse pigmentation.

Figure 2

Serial clinical and dermoscopic findings of ALMIS on the sole in a 47-year-old woman over 24 months. (A,D) At the first visit, a 2.5-mm brown macule with non-typical pattern was seen. (B,E) After 6 months, the lesion increased to 3 mm with darkening of colours. (C,F) At the 24-month follow-up visit, the lesion enlarged to 4.5 mm and parallel ridge pattern and asymmetry were seen on dermoscopy.

Figure 3

Our proposed management algorithm for acral lentiginous melanoma in situ. Abbreviations: LLP, lattice-like pattern; PFP, parallel furrow pattern; PRP, parallel ridge pattern; RFP, Regular fibrillar pattern.