How Acral Lentiginous Melanoma Is Treated

When detected early, acral lentiginous melanoma (ALM) can be cured by surgical removal. This procedure, called a wide local excision, is performed by a surgical oncologist (doctor specializing in cancer diagnosis and treatment). It is the mainstay of treatment for most ALM lesions. 

If ALM has spread, additional treatments, such as chemotherapy, may be needed. Unlike most skin cancers, ALM has no association with sun exposure. ALM accounts for 70% of melanomas in Black people, 46% in Asian people, and less than 10% in White people.

In this article, we will review the treatment options.

Surgeries and Specialist-Driven Procedures

A team of dermatologists (doctors specializing in the diagnosis and treatment of disorders of the skin, hair, and nails), oncologists, nurses, and support staff will likely help you to manage your care. These are the surgeries and specialist-driven procedures that you can expect should you see a healthcare professional for suspicion of AML.

Dermoscopy

AML lesions may be difficult to tell apart from noncancerous moles (benign nevi). Therefore, your dermatologist may use dermoscopy to confirm a diagnosis and get a better sense of the depth and other features of the tumor in question prior to surgery.

Dermoscopy is a special examination using a microscope and incandescent light to examine the detail of minute structures of the melanocytic skin lesions (abnormal changes in the skin that produce melanin, or pigments). Dermoscopy uncovers hard-to-see skin changes that are not visible by the naked eye.

Surgical Excision

If you are diagnosed with ALM, you will be referred to a surgical oncologist to have the tumor removed. Doctors in the field of surgical oncology specialize in the safe removal of acral melanoma tumors.

The most common procedure is a wide local excision. It is the mainstay therapy for ALM and is highly curative for early-stage melanomas. During this procedure, the entire tumor and a small amount of the healthy surrounding tissue will be removed.

Recommendations for definitive surgical margins (the amount of nearby healthy skin to be removed) are based on tumor thickness at the time of biopsy. If the surgery creates large defects, the surgeon may use additional techniques, such as skin grafting (using skin from another area of the body to close the wound) or flap reconstruction (closing the wound with nearby healthy skin tissue), to maintain the appearance of the skin.

Sentinel Lymph Node Biopsy and Other Procedures

In later stages of the disease, your healthcare provider may palpate (feel by physical touch) the nearby lymph nodes for enlargement. If they are larger than is normal, the surgeon will remove them.

If lymph nodes are not enlarged, a sentinel lymph node biopsy may be used to detect the presence of metastasis (spread of the cancer). In this procedure, the surgeon removes a small sample of the nearest lymph nodes and sends it to a lab so it can be tested for cancer cells.

If metastasis is found, other forms of treatment may be necessary.

Medications

Systemic (body-wide) treatments may be used to kill cancer cells that have metastasized. Potential treatments include:

• Chemotherapeutic agents: Chemotherapy medications are prescription drugs used to kill cancer cells throughout the body. They can be given orally by pill or intravenously by IV.
• Targeted mutational therapy: These are newer drugs being developed that work by attacking certain mutations or targets in cancer cells that cause them to change, grow, and divide. 
• Immune checkpoint inhibitors: These are drugs that use a person's own immune system to kill cancer cells. Recent clinical trials have demonstrated that immune checkpoint inhibitors can significantly improve the overall survival of patients with metastatic AML.
  

ALM tumors are not highly radiosensitive (meaning radiation doesn't kill the cancer cells effectively). But in rare cases, radiation therapy (high-energy X-ray beams meant to kill cancer cells) may be used for adjuvant treatment (supportive treatment alongside another treatment such as chemo), palliation (used to reduce symptoms and improve quality of life), or if there is evidence of recurrent disease.

Home Remedies and Lifestyle 

There are no home remedies or lifestyle factors approved to treat ALM.

However, it is important to note that some lifestyle factors, including avoiding or quitting smoking, maintaining a healthy, nutrient-rich diet, reducing your stress levels, and finding an exercise program that works for you may help you feel better and improve your outcomes as you navigate your cancer treatment and recovery.

Summary

Wide local excision is the mainstay treatment of acral lentiginous melanoma. ALM is highly curable when caught early, underscoring the importance of early diagnosis and treatment. Chemotherapy is mainly used if the cancer spreads to tissues outside of the primary site, while radiation may be used as a palliative care measure in end-stage metastatic situations.

A Word From Verywell 

Early diagnosis can be difficult because early ALM skin changes may be subtle, and symptoms may be nonspecific or not appear at all. Still, this type of skin cancer is aggressive and is prevalent in darker-skinned populations, so it's important to do regular self-checks and keep up with regular screenings to spot skin changes as early as possible.

Early treatment is less expensive and highly curable. If you have a family history of melanoma, see skin changes without being in the sun, or have a mole that doesn't look the same as usual, do not hesitate to get it checked out and address this issue should you suspect there is a problem.