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Description:This image depicts a patient’s left big toe from an inferior view, revealing a lesion involving the toe’s inferior and lateral surfaces, and if you look at PHIL 13427, you’ll see that it involves the nail bed as well. This lesion was subsequently diagnosed as acral lentiginous melanoma (ALM). It is important to note the location of this lesion, its irregularly-demarcated margins, the involvement of the nail bed, and the presence of what appears to be Hutchinson’s sign, all of which are characteristics that should inspire suspicions as to its classification.
Characteristics associated with ALM include the following:

- ALM most frequently occurs in the 6th to 7th decades of life

- These lesions manifest mostly on the feet and toes, followed by the hands, and then the mucous

- ALM lesions account for 5 – 10% of all malignant melanoma (MM), but 70% of MM in blacks, and
   approximately 45% in Asians

- ALM begins as an irregular macule, followed by the formation of a patch, and finally a nodule

- Subligual melanomas, which account for 1 – 3% of MM, are usually ALM, and one should look for
   Hutchinson’s sign, i.e., a brown discoloration of the cuticle

- Melanonchia striata, or brown streaks of the nail bed, may be an early sign of ALM

- Early diagnosis of ALM is often missed

High Resolution: Click here for hi-resolution image (5.82 MB)
Content Providers(s):CDC/ Carl Washington, M.D., Emory Univ. School of Medicine; Mona Saraiya, MD, MPH
Creation Date:2007
Photo Credit:
Links:CDC – Cancer Prevention and Control: Skin Cancer
CDC Organization
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Copyright Restrictions:None - This image is in the public domain and thus free of any copyright restrictions. As a matter of courtesy we request that the content provider be credited and notified in any public or private usage of this image.