Tasa de recurrencia e implicación del margen quirúrgico en la supervivencia del paciente con melanoma acral. ¿Es necesario un margen amplio? / Recurrence rate and survival implications of surgical margins in patients with acral melanoma. Is a wide margin necessary?

Resumen Introducción: La extensión apropiada de los márgenes de resección en el melanoma acral no está claramente establecida. Objetivo: Investigar si la escisión con margen estrecho es adecuada en el melanoma acral grueso. Métodos: Se estudiaron 306 pacientes con melanoma acral. Conforme a la extensión del margen quirúrgico (de 1 a 2 cm y > 2 cm), se analizaron los factores asociados a la recurrencia y la supervivencia. Resultados: De 306 pacientes, 183 fueron mujeres (59.8 %). La mediana del grosor de Breslow fue 6 mm; 224 casos (73.2 %) fueron de tipo ulcerados, 154 pacientes (50.3 %) tenían enfermedad en estadio clínico III, 137 en II (44.8 %) y 15 en IV (4.9 %). Todos los casos presentaron margen negativo, con una mediana de 31.5 mm. Un grosor de Breslow de 7 mm (p = 0.001) y la etapa clínica III (p = 0.031) se asociaron a recurrencia; los factores asociados a la supervivencia fueron el índice de Breslow (p = 0.047), la ulceración (p = 0.003), la etapa clínica avanzada (p < 0.001) y el uso de adyuvancia (p = 0.003). Conclusión: Un margen de resección de 1 a 2 cm no afectó la recurrencia tumoral ni la supervivencia en los pacientes con melanoma acral.

Abstract Introduction: Appropriate size of resection margins in acral melanoma is not clearly established. Objective: To investigate whether narrow-margin excision is appropriate for thick acral melanoma. Methods: Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm). Results: Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003). Conclusion: A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.

Dermoscopic features and management strategy of a 10-year history acral lentiginous melanoma in a 55-year-old Filipino

Introduction@#Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians that is not associated with ultraviolet radiation (UV) exposure. Dermoscopy enables clinicians to distinguish between benign and malignant acral melanocytic lesions, with some dermoscopic characteristics playing a role in staging and have prognostic implications, which allows for appropriate surgical intervention. The difficulty of making an early diagnosis of ALM is highlighted by this case. ALM’s destructive nature, alongside the patient’s lack of awareness and vigilance, and healthcare access inequality, influences its prognosis. @*Case Report@#This is a case of a long-standing acral lentiginous melanoma with no palpable lymphadenopathies in which it was not immediately detected through biopsy. Upon detection, wide excision with 2 cm margins and disarticulation of the 5th digit of the right foot reconstructed with a fasciocutaneous advancement flap with split thickness skin graft, grafted from the right anterior thigh was done.

Human leukocyte antigen Class II alleles associated with acral lentiginous melanoma in Mexican Mestizo patients: A case-control study

Background: Melanoma is an aggressive cutaneous cancer. Acral lentiginous melanoma is a melanoma subtype arising on palms, soles, and nail-units. The incidence, prevalence and prognosis differ among populations. The link between expression of major histocompatibility complex Class II alleles and melanoma progression is known. However, available studies report variable results regarding the association of melanoma with specific HLA Class II loci. Aims: The aim of the study was to determine HLA Class II allele frequencies in acral lentiginous melanoma patients and healthy Mexican Mestizo individuals. Methods: Eighteen patients with acral lentiginous melanoma and 99 healthy controls were recruited. HLA Class II typing was performed based on the sequence-specific oligonucleotide method. Results: Three alleles were associated with increased susceptibility to develop acral lentiginous melanoma, namely: HLA-DRB1*13:01; pC = 0.02, odds ratio = 6.1, IC95% = 1.4–25.5, HLA-DQA1*01:03; pC = 0.001, odds ratio = 9.3, IC95% = 2.7–31.3 and HLA-DQB1*02:02; pC = 0.01, odds ratio = 3.7, IC95% = 1.4–10.3. Limitations: The small sample size was a major limitation, although it included all acral lentiginous melanoma patients seen at the dermatology department of Dr. Manuel Gea González General Hospital during the study period. Conclusion: HLA-DRB1*13:01, HLA-DQB1*02:02 and HLA-DQA*01:03 alleles are associated with increased susceptibility to develop acral lentiginous melanoma in Mexican Mestizo patients.

Psychogenic Dermatitis In A Corgi Dog Treated By Injectable Homeopathy - Case Report

Skin problems in dogs represent a daily important casuistic in veterinary practices. They affect both young and adult animals and may have varied causes, challenging the correct diagnosis.Within this context, it should be emphasized the close coexistence and attachment to their owners who play a crucial role in the development and treatment of part of the so-called psychogenic dermatitis. This type of illness must be understood as a multifactorial problem that requires a lot from all parties involved to be an effective therapy for the patient. Several medicines are indicated for the treatment, but most of them cause long-term side effects. For these reasons, different therapies, such as homeopathy, should be considered as alternative treatments. This article aimed to report a psychogenic dermatitis case in a 10-year-old male dog suffering from separation anxiety, which led to the development of a compulsive licking behavior. The patient was treated with injectable homeopathic medicines, and excellent results were recorded in a short period.

Analysis of prognostic factors for acral lentiginous melanoma based on SEER database / 中华皮肤科杂志

Objective:To investigate prognostic factors for acral lentiginous melanoma (ALM) , and to construct a nomogram to verify the predictive value of these factors.Methods:Clinical data on 1 573 patients with ALM were collected from the Surveillance, Epidemiology, and End Results (SEER) database of National Cancer Institute in United States between 2004 and 2015. Data about patients′ age, gender, ulcer status, SEER staging, surgical protocols, T-, N- and M-staging, overall survival rates and disease-specific survival rates were extracted. Chi-square test was used to analyze the correlation of clinical characteristics with overall survival rates and melanoma-specific survival rates, and univariate and multivariate Cox proportional hazards regression models were used to investigate prognostic factors and establish predictive models.Results:Among the 1 537 patients with ALM, 714 were males, 823 were females, 818 were under 64 years of age, and 1 363 were Caucasian. Skin lesions occurred on the lower limbs and buttocks in 1 205 cases, and 974 cases had ulcers; according to the SEER staging, non-spread localized skin lesions were observed in 1 048 cases. There were significant differences in the mortality rate among patients of different ages at diagnosis, different gender, with different ulcer status, surgical status, and at different SEER stages, T-stages, N-stages and M-stages (all P < 0.001) . Univariate and multivariate Cox regression analysis showed that age ≥ 65 years, male, ulcers and distant lymph node metastasis in the SEER staging were associated with increased risk of death in the patients (all P < 0.05) , and the mortality rate was significantly higher in the patients with T2-, T3- or T4-stage ALM than in those with T1-stage ALM (all P < 0.05) , and higher in the patients with N1-, N2- and N3-stage ALM than in those with N0-stage ALM (all P < 0.05) . Conclusion:Age, gender, ulcer status, SEER stage, T-stage and N-stage are independent prognostic factors for overall survival rates and disease-specific survival rates of ALM.

A case of acral fibrochondromyxoid tumor / 中华皮肤科杂志

A 44-year-old male patient presented with a subcutaneous nodule in the left little finger for 3 years. Skin examination showed a subcutaneous nodule with rubber-like hardness but no tenderness on palpation, measuring 0.4 cm × 0.4 cm in size at the dorsal distal aspect of the left little finger, and the movement of the distal interphalangeal joint was unrestricted. Postoperative histopathological examination revealed that the tumor contained abundant stroma consisting of variable fiberous, chondroid and myxoid materials; tumor cells were oval to short spindle-shaped with inconspicuous nucleoli but no mitosis; cells were arranged haphazardly or in small clusters. Immunohistochemical study showed positive staining for vimentin, CD34 and transcription factors ERG and SOX9, but negative staining for S100, P63, broad-spectrum cytokeratin AE1/AE3, epithelial membrane antigen, smooth muscle actin and desmin in tumor cells, and the Ki67 labeling index was below 1%. Finally, the patient was diagnosed with acral fibrochondromyxoid tumor.

Melanoma Lentiginoso Acral Revisión Narrativa de uno de los Melanomas más Frecuentes en América Latina / Acral lentiginous melanoma: Review of one of the most frequent melanomas in Latin America

Resumen El melanoma es el cáncer de piel con mayor tasa de mortalidad a nivel mundial. Se han descrito 4 subtipos principales de melanoma cutáneo: el melanoma de extensión superficial, el melanoma nodular, el léntigo maligno y el melanoma lentiginoso acral. Existen diferencias raciales y geográficas en la distribución y frecuencia de estos subtipos. En caucásicos, el riesgo es mayor para melanomas de piel expuesta a radiación UV, ya sea de forma crónica o intermitente. En contraste, en asiáticos, afroamericanos e hispanos, la tendencia es mayor en sitios anatómicos no expuestos (palmas y plantas), encabezando el melanoma lentiginoso acral en una proporción mayor. Usualmente, este melanoma se diagnostica de manera tardía y en estadios avanzados, por cual se asocia con un peor pronóstico. La presente revisión pretende brindar una visión general sobre el conocimiento del melanoma lentiginoso acral, describiendo aspectos como la epidemiología, los factores de riesgo asociados, las características genéticas y los factores pronósticos.

Abstract Melanoma is the cutaneous cancer with the highest mortality worldwide. Four main subtypes of cutaneous melanoma have been described: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. There are racial and geographical differences in the distribution and frequency of these subtypes. In Caucasians, the risk is higher to develop melanoma on skin exposed to UV radiation, either chronically or intermittently. In contrast, in Asians, African Americans, and Hispanics, there is a greater tendency towards unexposed anatomical sites (palms and soles), which is called acral lentiginous melanoma. This melanoma is usually diagnosed in advanced stages, and therefore has a worse prognosis. This review aims to provide an update on what is known about acral lentiginous melanoma, mainly describing its epidemiology, risk factors associated with genetic characteristics, and prognosis.

Variables pronósticas de pacientes con melanomas gruesos. Análisis de 362 casos / Prognostic variables in patients with thick melanomas. Analysis of 362 cases

Resumen Antecedentes: Los estudios sobre factores pronóstico de melanoma están basados en poblaciones caucásicas, con predominio de melanomas delgados (Breslow < 3 mm). Los pacientes mexicanos muestran predominio de melanomas gruesos (Breslow ≥ 3 mm). Objetivo: Identificar factores asociados al pronóstico de pacientes con melanomas gruesos. Material y métodos: Se analizó la influencia pronóstica de factores clinicopatológicos en 362 melanomas gruesos. Resultados: La mediana de Breslow fue de 7 mm, 271 (74.9 %) pacientes tuvieron melanoma acral y 49 (13.5 %) melanoma nodular. El 56.6 % de los pacientes se encontró en etapa clínica [EC] III), 269 (74.3 %) tenía ulceración y 15 (4.1 %) márgenes positivos. Las variables asociadas con menor supervivencia global [SG] fueron la EC (p < 0.001), Breslow (p = 0.044), ulceración (p = 0.004), mitosis (p < 0.001) y margen < 2 cm (p < 0.001) . En el análisis multivariante los factores que influyen en SG fueron la EC, mitosis y el margen quirúrgico. Conclusiones: En pacientes con melanomas gruesos la SG es influida por un margen positive, mitosis y EC.

Abstract Background: Studies on prognostic factors in melanoma are based on Caucasian populations, with a predominance of thin melanomas (Breslow <3 mm). Mexican patients show a predominance of thick melanomas (Breslow ≥ 3 mm). Objective: To identify factors associated with the prognosis of patients with thick melanomas. Material and methods: The prognostic influence of clinicopathological factors was analyzed in 362 thick melanomas. Results: The Breslow median was 7 mm, 271 (74.9 %) patients had acral melanoma and 49 (13.5 %) nodular melanoma. The 56.6 % of patients were found in clinical stage [CS] III), 269 (74.3 %) had ulceration, and 15 (4.1 %) had positive margins. The variables associated with lower overall survival [OS] were CS (p < 0.001), Breslow (p = 0.044), ulceration (p = 0.004), mitosis (p < 0.001) and margin < 2 cm (p < 0.001). In the multivariate analysis, the factors influencing OS were CD, mitosis, and the surgical margin. Conclusions: In patients with thick melanomas, OS is influenced by a positive margin, mitosis and CS.

Melanoma subungueal: un reto diagnóstico para los médicos / Subungual melanoma: a diagnostic challenge for doctors

El melanoma subungueal es un subgrupo del melanoma acral lentiginoso. Con frecuencia se diagnostica en etapa avanzada, dada la escasez de síntomas; de ahí que la evaluación y el tratamiento oportuno mejoran el pronóstico. Se presenta el caso de un paciente de 44 años de edad, que acude a consulta de Ortopedia con melanoniquia de tres meses de evolución. Había sido tratado en la atención primaria de salud por un hematoma secundario a un trauma directo sobre la falange distal del primer artejo del pie izquierdo. Fue seguido por consulta externa de Ortopedia y, al no experimentar una evolución adecuada, fue evaluado por la Comisión Provincial de Tumores Periféricos. Se le realizó una biopsia por punch (sacabocado), que arrojó el resultado de melanoma subungueal. Se realizó la amputación del primer artejo y del proximal del primer metatarsiano, una vez verificada la no existencia de lesiones metastásicas, con excelente resultado estético y funcional, sin mostrar recidiva en su seguimiento, a dos años de su intervención(AU)

Subungual melanoma is a subgroup of lentiginous acral melanoma. It is often diagnosed in an advanced stage by a shortage of symptoms, so timely evaluation and treatment improve prognosis. This is the case of a 44-year-old patient who goes to orthopedics with melanonichia 3 months of evolution. He had been treated for a bruise secondary to direct trauma to the distal phalanx of the first left foot ailre in primary health care. It was followed by external orthopedic consultation and by not following an adequate evolution was evaluated by the provincial commission of peripheral tumors. He was given a punch biopsy resulting in a subungual melanoma. The amputation of the first artejo and proximal first metatarsal was carried out, once verified the non-existence of metastatic lesions, with excellent aesthetic and functional result, without showing relapse in its follow-up to two years(AU)

Clinical and pathological features of acral pseudolymphomatous angiokeratoma of children: a case report / 中华皮肤科杂志

A 13-year-old female patient presented with itchy rashes on the right foot for 5 years. Skin examination revealed scattered flat, reddish-purple, slightly scaling papules on the inner side of the arch of the right foot, scattered light red papules on the outer side of the right great toe, and scattered domed reddish-purple papules on the right heel with collar-shaped keratinization around the base. Histopathological examination of the papule on the right heel revealed epidermal hyperkeratosis, marked hyperkeratosis around the papule, thickened granular layer and focal liquefaction degeneration of the basal layer with no obvious hyperplasia of the spinous layer; a large number of lymphocytes and plasma cells without atypia infiltrated the dermis, in which there were many small- and medium-sized dilated thick-walled blood vessels lined with prominent plump endothelial cells. The patient was diagnosed with acral pseudolymphomatous angiokeratoma of children, and treated with long-pulsed 1 064-nm Nd: YAG laser once every month. After 7 sessions of treatment, the rashes regressed and decreased in number.

Soluble PD-L1 as a prognostic factor for advanced acral and mucosal melanoma / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: Elevated levels of soluble PD-L1 (sPD-L1) are associated with worse prognosis of renal cell carcinoma and multiple myeloma. However, the regulatory roles and functions of sPD-L1 in advanced melanoma are not fully understood. This study was designed to evaluate the association between circulating sPD-L1 concentrations and prognosis of patients with advanced acral or mucosal melanoma. Methods: A total of 102 untreated patients with advanced acral and mucosal melanoma admitted to Peking University Cancer Hospital between January 2012 and December 2015 were enrolled in this study. In the meanwhile, peripheral blood samples were obtained from 40 healthy donors. Circulating sPD-L1 concentrations were determined using an enzyme-linked immunosorbent assay. Results: The advanced melanoma cohort included 58 acral melanoma patients and 44 mucosal melanoma patients. The pre-treatment concentration of sPD-L1 (2.91±2.23 ng/ml) in plasma of patients group was elevated as compared with that in healthy donors (0.59 ng/ml). The concentration of sPD-L1 in serum was significantly upregulated in 39/102 (38.2%) patients and significantly associated with increased LDH level (P=0.021) and number of Tregs (P=0.017). The overall survival rates of patients with high or low concentrations of sPD-L1 were statistically different (8.5 months [high level] vs 11.6 months [low level], P=0.022). Conclusion: sPD-L1 concentration is elevated in patients with advanced acral or mucosal melanoma, which may play an important role in predicting prognosis.

Dermatoscopía de nevos melanocíticos congénitos acrales: puesta al día / Dermoscopy of melanocytic nevi acral congenitals: update

Los nevos melanocíticos congénitos (NMC) son aquellos presentes al nacer o que se desarrollan durante los primeros dos años de vida. Hay muy pocos casos documentados de melanoma lentiginoso acral en asociación con nevos preexistentes en comparación a otros subtipos de melanoma. De éstos, la mayoría serían asociados a nevos melanocíticos adquiridos acrales (NMAA) y muy excepcionalmente asociados a nevos melanocíticos congénitos acrales (NMCA). Sin embargo, la extirpación de lesiones pigmentadas acrales congénitas es practicada con frecuencia y se desconocen los patrones dermatoscópicos más característicos, así como tampoco se disponen de algoritmos de seguimiento. A continuación, presentamos dos casos de NMCA con patrones dermatoscópicos característicos y realizamos una revisión de los patrones dermatoscópicos más comunes de NMCA descritos en la literatura.

Congenital melanocytic nevi (CMN) are those present at birth or that develop during the first two years of life. There are very few documented cases of acral lentiginous melanoma in association with pre-existing nevi compared to other subtypes of melanoma. Of these, the majority would be associated with acral acquired melanocytic nevi (NMAA) and very exceptionally associated with acral congenital melanocytic nevi (NMCA). However, the excision of congenital acral pigmented lesions is frequently practiced and the most characteristic dermoscopic patterns are unknown, nor are there any follow-up algorithms. In the following, we present two cases of NMCA with characteristic dermoscopic patterns and a review of the most common dermoscopic patterns of NMCA described in the literature

A case of necrolytic acral erythema / 中华皮肤科杂志

A 25-year-old female patient presented with itchy rashes on her feet for 10 years.Skin examination showed dark red plaques with clear boundaries,whose surfaces were covered with grey-brown scales,on the dorsum of toes and adjacent dorsum of the feet,the extensor aspect of the right ankle and the left Achilles tendon.Laboratory tests revealed that serum anti-hepatitis C virus (HCV) antibody was negative and HCV-RNA quantity was normal.Histopathological examination showed epidermal hyperkeratosis with parakeratosis,irregularly thickened spinous layer,scattered dyskeratotic cells and necrotic keratinocytes in the middle and upper spinous layer,focal liquefaction degeneration of basal cells,dilatation of small blood vessels in the superficial andmiddle dermis,and perivascular infiltration of a small number of lymphocytes.The patient was diagnosed with necrolytic acral erythema without hepatitis C.After 2-month treatment,the skin lesions completely regressed,and hyperpigmentation remained.

Acral Involvement in a Typical Case of Acanthosis Nigricans / 대한피부과학회지

No abstract available.

A Case of Superficial Acral Fibromyxoma Showing Erythronychia / 대한피부과학회지

No abstract available.

A case of necrolytic acral erythema / 中华皮肤科杂志

A 25-year-old female patient presented with itchy rashes on her feet for 10 years. Skin examination showed dark red plaques with clear boundaries, whose surfaces were covered with grey-brown scales, on the dorsum of toes and adjacent dorsum of the feet, the extensor aspect of the right ankle and the left Achilles tendon. Laboratory tests revealed that serum anti-hepatitis C virus (HCV) antibody was negative and HCV-RNA quantity was normal. Histopathological examination showed epidermal hyperkeratosis with parakeratosis, irregularly thickened spinous layer, scattered dyskeratotic cells and necrotic keratinocytes in the middle and upper spinous layer, focal liquefaction degeneration of basal cells, dilatation of small blood vessels in the superficial and middle dermis, and perivascular infiltration of a small number of lymphocytes. The patient was diagnosed with necrolytic acral erythema without hepatitis C. After 2-month treatment, the skin lesions completely regressed, and hyperpigmentation remained.

Acral angioosteoma cutis: A rare case

Acral angioosteoma cutis is a rare and benign cutaneous lesion clinically characterized by an exophytic growth resembling pyogenic granuloma on the acral skin; first described in 2006. Its pathogenesis is still unclear while well-formed capillaries, pale stroma, bland fibroblast-like cells, and multiple tiny spicules of woven bone constitute the histological hallmarks. Here, we present a case of acral angioosteoma cutis in a 34-year-old man to increase awareness regarding this rare condition.

A Case of Focal Acral Hyperkeratosis with Autosomal Dominant Inheritance / 대한피부과학회지

Focal acral hyperkeratosis (FAH) is a rare genodermatosis inherited by autosomal dominant transmission; however, some sporadic cases have also been reported. FAH is characterized by multiple late-onset crateriform hyperkeratotic papules with a yellow color on the border of the hands and feet. A 31-year-old man presented with yellowish discrete flat-topped papules on the lateral side of his palms and fingers. The patient had a family history of similar lesions throughout three generations. The histological findings revealed hyperkeratosis with mild hypergranulosis in the epidermis, and the dermis showed no specific changes including elastorrhexis. These clinicopathologic findings were consistent with the diagnosis of FAH. Herein, we report a rare case of FAH with autosomal dominant inheritance.

Increased Expression of Dickkopf-1 in Acral Lentiginous Melanoma / 대한피부과학회지

BACKGROUND: Dickkopf-1 (DKK-1), an inhibitor of the Wnt signaling pathway, is known as an inhibitor of melanocyte proliferation. In recent studies, the expression of DKK-1 gene is reduced in melanoma and they lose their preventive role during development or progression of melanoma. There are no available data regarding the changes in DKK-1 gene expression in acral lentiginous melanoma (ALM), which is common in Asians. OBJECTIVE: To analyze changes in DKK-1 expression in the development or progression of ALM in Koreans. METHODS: Immunohistochemical staining using DKK-1 antibody of 13 invasive ALM, six ALM in situ, nine acral nevi, and four benign non-related palmoplantar specimens as controls were evaluated by the semi-quantitative grading scale, which is divided into three distinctive grades according to the degree of cytoplasmic staining of DKK-1. RESULTS: Among the invasive ALM specimens, seven of 13 (53.8%) were graded as strongly positive (2+), and only one case (7.7%) was negative. In cases of ALM in situ, two specimens (33.3%) stained positive (1+) and the remaining four specimens (66.6%) were not stained. All specimens from both acral nevus and benign palmoplantar lesions, which were used as the control group, were also negative. CONCLUSION: In contrast with recent reports, DKK-1 expression showed a positive correlation with ALM progression or invasiveness. The role of DKK-1 as a potential predictor of ALM progression warrants further study.

Genética molecular del melanoma lentiginoso acral / Molecular genetics of acral lentiginous melanoma

En la última década se ha avanzado en la caracterización genética y mapeo molecular del melanoma cutáneo con el objetivo de identificar y comprender mejor los mecanismos patogénicos propios de cada subgrupo y así desarrollar tratamientos específicos. El melanoma lentiginoso acral (MLA) constituye un subtipo de melanoma con características clínicas, epidemiológicas, histopatológicas, pronósticas y terapéuticas distintivas y su perfil mutacional no es la excepción. A diferencia del melanoma ubicado en zonas fotoexpuestas, el MLA presenta una baja tasa de mutaciones BRAF (15%) y mayor frecuencia de amplificaciones y ganancias genéticas de KIT (15-30%), CCND1 (15-40%) y TERT (20%). En esta revisión se describen las características más relevantes del MLA con énfasis en el rol que cumplen los principales genes que participan en la patogenia del MLA.

Over the last decade, the genetic characterization and molecular mapping of cutaneous melanoma has been developed in order to identify and better understand the pathogenic mechanisms of each subgroup and to develop specific treatments. Acral lentiginous melanoma (ALM) is a melanoma subtype with distinctive clinical, epidemiological, histopathological, prognostic and therapeutic features and its mutational profile is not an exception. Unlike melanoma located in photoexposed areas, MLA has a low rate of BRAF mutations (15%) and a higher frequency of amplifications and genetic gains at KIT (15-30%), CCND1 (15-40%) and TERT (20%). In this review we will describe the most relevant characteristics of MLA with emphasis on the role of the main genes involved in its pathogenesis.