Acral lentiginous melanoma is a form of cutaneous melanoma. It is the most rare form of melanoma, and can strike anyone at any time, though it tends to occur more frequently in African-Americans and Asians and people over 60. It usually appears on your soles, palms, mucous membranes such as the mouth or nose, or under a nail. Treatment typically involves surgery; if the melanoma has spread, chemotherapy or radiation would be the next step.
Symptoms
Symptoms depend on the location. If ALM occurs under the nail, it typically presents with a darkened base or a longitudinal streak on the nail that can appear black, tan or brown (melanonychia striata). Other discolorations or streaks may indicate ALM as well. If it appears on the palms or the soles, it presents with dark pigmented areas, similar to other types of skin cancer. Other symptoms can include marks similar to bruising on the skin or dark pigmentation on the mucous membranes.
If you experience any of these symptoms, see a physician immediately. Early diagnosis is essential for successful treatment and to prevent the cancer from metastasizing. Diagnosis is often difficult due to the symptoms tending to be overlooked, and careful inspection of the hands, feet, and mouth is essential to detecting the cancer early.
Surgery
The most common form of melanoma treatment is surgical excision, as 95 percent of all melanomas are treated successfully with surgery. This is often combined with lymph node dissection and, if the cancer has spread, radiation or chemotherapy. Surgery is most effective when the cancer has not reached deeper than approximately 4 millimeters and has yet to spread to the lymph nodes. Melanomas under the nail may require complete removal of the nail.
At times the area of skin removed may be quite large, and therefore a skin graft, which is the removal of skin from one part of the body and placed on another, may need to be used to cover the area removed.
Chemotherapy and Radiation
If the melanoma has spread from the skin to other organs, surgery will need to be used in conjunction with chemotherapy or radiation therapy. Chemotherapy involves cancer-killing drugs, such as dacarbazine, administered intravenously or orally. Radiation therapy involves high-energy beams aimed directly at the tumor. The effectiveness of chemotherapy on melanomas is minimal, and the prognosis for melanoma that has spread to other organs is quite poor, often leading to death.
Interferon
For patients whose cancer has spread to the lymph nodes or is deeper than 4 millimeters, interferon may help. Interferon is a form of immunotherapy, designed to increase the strength of the immune system. While it can be helpful, it typically causes serious side effects, such as flu-like symptoms, diarrhea and fatigue. It is usually recommended that only the healthiest patients undergo interferon therapy.
Other Treatments
The most effective method of treating acral lentiginous melanoma is surgical excision, but the disease must be caught during the early stages. Spreading of the disease might require more intensive surgery beyond chemotherapy/radiation and interferon, Experimental treatments include gene therapy, anti-angiogenic chemotherapy (preventing new blood vessels from forming) and biologic therapy. Beyond this, patients with stage three or four skin cancer may enroll in clinical trials to try new, experimental therapies that have yet to be approved by the FDA.
Tags: under nail, cancer spread, chemotherapy radiation, deeper than, form melanoma, lentiginous melanoma