Acral Lentiginous Melanoma
An acral lentiginous melanoma. Picture used with kind permission from Stuart Waterston and the University of Aberdeen
Although this lesion could be a simple haematoma under the nail, it is important to consider the possibility of an acral lentiginous melanoma. This can usually, but not always, be determined from the patient history
Note the indistinct "blotchy" discolouration of the nail. This is a long standing lesion which appears quite different to subungual haematoma.
Features
Clinically, this sub-type occurs on the hands and feet, including the digits and sub-ungual areas. The soles of the feet are most commonly affected. It is apparent as a black, raised lesion.
Tumours are frequently misdiagnosed as subungual haematomas or verrucous warts. Acral lentiginous melanomas are not attributed to sun exposure.
Incidence
This is relatively uncommon in white people (2-8% of melanoma), but accounts for 29-72% of melanoma in those of Hispanic, African American or Asian descent.
