ADVANCEMENTS IN UNDERSTANDING AND MANAGING ACRAL LENTIGINOUS MELANOMA: A COMPREHENSIVE REVIEW

Ajith*, Vineetha K. and A. R. Shabaraya

ABSTRACT

Acral lentiginous melanoma (ALM) is a rare subtype of melanoma with distinct clinical, histological, and molecular characteristics. Unlike other cutaneous melanomas, ALM primarily affects non-hair-bearing skin, such as the palms, soles, and nail beds, and is not associated with sun exposure. Its unique epidemiological distribution, being more prevalent in non-White populations, underscores the need for tailored management strategies. Diagnosis of ALM requires careful clinical and histological evaluation, often necessitating specialized techniques such as dermoscopy and nail unit biopsies. Surgical excision remains the mainstay of treatment for localized disease, but challenges in achieving complete excision, especially in subungual melanomas, highlight the importance of alternative approaches. Advancements in molecular profiling have identified key genetic mutations driving ALM, paving the way for targeted therapies and immunotherapy. BRAF/MEK inhibitors have shown efficacy in BRAF-mutant melanomas, while KIT and CDK4/6 inhibitors hold promise in specific genetic subgroups. Immunotherapy, including immune checkpoint inhibitors and oncolytic viruses, offers novel treatment options, either alone or in combination with other modalities. Combination therapies, such as immunotherapy with chemotherapy or antiangiogenic agents, represent a promising approach to overcome resistance mechanisms and improve treatment outcomes in advanced ALM. Further research and clinical trials are warranted to refine treatment algorithms and optimize outcomes for patients with ALM.

Keywords: Acral lentiginous melanoma, Dermoscopy, BRAF/MEK inhibitors, Immune checkpoint inhibitors.