Acrolentiginous Melanoma

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Description This chapter describes the dermoscopyDermoscopy is a non invasive diagnostic method. criteriaThis glossary term has not yet been described. of melanocyticThis glossary term has not yet been described. lesions in acralAcral melanoma is a type of skin cancer that occurs on fingers, palms, soles, and nail beds. sites.
Author(s) Ralph P. Braun · Luc Thomas
Owner Ralph Braun→ send e-mail
Status released
Status update June 25, 2017
Status by Ralph P. Braun
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Anatomy of palmsThis glossary term has not yet been described. and solesThis glossary term has not yet been described.

The unique appearance of the skin on palms and soles is due to the presence of alternating furrows and ridges, which are responsible for creating our individualized dermatoglyphic patterns (fingerprints) The location of pigment in relationship to the furrows and ridges can help in differentiating benignThis glossary term has not yet been described. neviThis glossary term has not yet been described. from melanomaThis glossary term has not yet been described.. DermoscopyDermoscopy is a non invasive diagnostic method. helps more precisely localize the pigment and has been shownmto significantly improve the observer’s diagnostic accuracy when evaluating volar melanocytic tumors. Numerous specific dermoscopic patterns have been defined for nevi and melanoma located on acral sites. In benign melanocytic tumors, the location of the pigment tends to favor the crista limitans, which corresponds to the furrows of the skinThis glossary term has not yet been described.. Recentresearch has revealed that acral nevi may be located at he tips of rete ridgeThis glossary term has not yet been described. sassociated with the crista intermedia and limitans; however, they preferentially transfer melanin to the keratinocytes associated with the furrow. In melanoma the malignantThis glossary term has not yet been described. melanocytes tend to cluster around the crista intermedia, which in turn often results in pigment located on the ridges. Lesions on volar skin that manifest any of the melanoma-specific structures (malignant patterns).

Anatomy of acral skin schematic 2.jpg
Anatomy of acral skin schematic 1.jpg

BenignThis glossary term has not yet been described. dermoscopy pattern [1][2]

Parallel furrow patternVolar pigmentation forming solid or dotted lines, parallel, thin, on the furrows (sulci superficiales or invaginations in dermatoglyphics). The lines are occasionally doubled, each line is beside the furrows.

Linear pigmentation, predominantly localized to the furrows. The ridges are relatively hypopigmented.

Paralel furrow pattern schematic.jpg
Paralel furrow pattern double dotted variant schematic.jpg
Paralel furrow pattern double line variant schematic.jpg

Lattice-like patternVolar pigmentation forming thin lines, parallel on the furrow or sulci superficialis (invaginations in dermatoglyphics) and crossing perpendicular on the ridges

Similar to the parallel furrow patternVolar pigmentation forming solid or dotted lines, parallel, thin, on the furrows (sulci superficiales or invaginations in dermatoglyphics). The lines are occasionally doubled, each line is beside the furrows. with the addition of parallel pigment bands that cross over the ridges from one furrow to the next.Pattern can chow some dotsThis glossary term has not yet been described.

Lattice like pattern schematic.jpg

Fibrillar patternLinear pigmented filamentous lines of similar length with one end at the furrows and oriented at a certain angle to the furrows and crossing the ridges

Dense fibrillar pigmentation composed of multiple thin parallel lines that cross both the furrows and ridges; the lines have a transverse orientation in relation to the furrows and ridges

Fibrillar pattern schematic.jpg
Atypical fibrillar pattern schematic.jpg


MalignantThis glossary term has not yet been described. dermoscopy pattern

Parallel ridge patternVolar pigmentation forming lines, parallel, diffuse and irregular, along the ridges or cristae superficiales (raised portion of the dermatoglyphics)

Linear pigmentation of the ridges. The furrows are relatively hypopogmented.

Parallel ridge pattern schematic.jpg

Diffuse pigmentation of variable shades of brown

Diffuse pigmentation of different shades of brown colorColor (American English) or colour (Commonwealth English) is the characteristic of human visual perception described through color categories, with names such as red, yellow, purple, or blue. not respecting furrows or ridges.

Diffuse pigmentation schematic.jpg

Multicomponent pattern

Combination of many pigmentation patterns (multicomponent patternThis glossary term has not yet been described.)

Multicomponent pattern schematic.jpg


Atypical fibrillar patternLinear pigmented filamentous lines of similar length with one end at the furrows and oriented at a certain angle to the furrows and crossing the ridges

A fibrillar pattern that is very heterogeneous, that is asscociated with another malignant pattern, or that is not located on the areas of the foot bearing the body pressure is called atypical fibrillar pattern. This should be considered with precaution.


Atypical fibrillar pattern schematic.jpg

Milky red areasMilky-white appearance or pinkish structureless areas ("strawberry and ice cream"-like), consisting a red vascular blush with no specific distinguishable vessels

Presence of reddish whitish colors. This is mainly seen in thick tumors when there is a nodular component which is vascularized. Most of the time this part is raised or even nodular and and associated with a multicomponent pattern.


Milky red areas schematic.jpg

BRAAFF AlgorithmIn mathematics and computer science, an algorithm (Listeni/ˈælɡərɪðəm/ AL-gə-ri-dhəm) is a self-contained sequence of actions to be performed. Algorithms can perform calculation, data processing and automated reasoning tasks.:

This alrogithm has been proposed recently by Lallas et al. [3]
B Irregular Blotch +1
R Parallel Ridge Pattern +3
A Asymmetry of Structures +1
A Asymetry of colors +1
F Parallel Furrow Pattern -1
F Fibrillar Pattern -1


1 pointThis glossary term has not yet been described. is required to make the diagnosisThis glossary term has not yet been described. of melanoma.



References:
  1. Braun et al.: Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society. Dermatology (Basel) 2013;227:373-80. PMID: 24296632. DOI.
  2. Phan et al.: Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br. J. Dermatol. 2010;162:765-71. PMID: 19922528. DOI.
  3. Lallas et al.: The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma. Br. J. Dermatol. 2015;173:1041-9. PMID: 26211689. DOI.