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Year : 2000  |  Volume : 66  |  Issue : 1  |  Page : 37-38

Acral lentiginous melanoma

S Khandpur, BSN Reddy 
 

Correspondence Address:
S Khandpur


Abstract

A 45-year-old man with acral lentiginous melanoma (AJCC Stage IV) of the left sole and lymph node metastasis is described. Three cycles of palliative combination chemotherapy administered to him resulted in the decrease of inguinal lump, however, the lesion over sole showed no variation.



How to cite this article:
Khandpur S, Reddy B. Acral lentiginous melanoma.Indian J Dermatol Venereol Leprol 2000;66:37-38


How to cite this URL:
Khandpur S, Reddy B. Acral lentiginous melanoma. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Sep 19 ];66:37-38
Available from: http://www.ijdvl.com/text.asp?2000/66/1/37/4862


Full Text

 Introduction



Acral lentiginous melanoma (ALM) is the fourth clinicopathologic variant of malignant mela­noma recognized and introduced by Reed in 1975. [1] It occurs commonly over the volar surface of hands and feet, subungual areas, fingers and toes. ALM probably represents the commonest expression of melanoma in blacks and constitutes only 10% of all melanomas on white skin.[2] It is characterized by a lentiginous (radial) growth phase that evolves over months to years to a dermal (vertical) invasive stage.

We report a case of ALM Stage (AJCC stag­ing) over sole in a 45-year-old man. As far as ascer­tained, we could not come across any documenta­tion of ALM from India, although superficial spread­ing' and nodular melanomas [4] have been reported.

 Case Report



A 45-year-old man presented with a brown­ish black ulcerated growth over the left sole and a lump in the left groin. It started 3 years back as a dark coloured asymptomatic patch with regular bor­der that gradually increased in size with blurring of the margin. A soft swelling appeared within the le­sion over the next 3-4 months that broke down caus­ing pain while walking. It was followed 2 years later by an asymptomatic lump over left groin that slowly increased in size, became painful and ruptured dis­charging pus and necrotic slough. No history of an­orexia, weight loss, cough, haemoptysis, seizures, bone pains, urinary or bowel complaints was present. His personal and family history were not contribu­tory.

Dermatologic examination revealed a brown­ish black plaque over the left sole 6X5 cm. in size, with irregular blurred margin and ulceration over lat­eral aspect. [Figure 1] Left inguinal region showed en­larged lymph nodes that were tender, hard, matted and fixed to underlying tissues with ulceration of overlying skin discharging pus and necrotic mate­rial. In addition, left external iliac lymph nodes were also palpable. Rest of the mucocutaneous and sys­temic examination revealed no abnormality.

Routine laboratory investigations including haematological, biochemical and radiological (X-Ray chest, skull, foot, CT scan of head, USG abdomen) were within normal limits. FNAC from left inguinal lymph nodes was consistent with metastatic mela­noma. Histopathology of the lesion over foot revealed hyperkeratosis, acanthosis, elongation of rete ridges, junctional activity with descending atypical melano­cytes in epitheloid pattern throughout the dermis and ascent of atypical cells in the epidermis suggesting epitheloid type of malignant melanoma.

The patient was diagnosed as a case of ALM Stage IV (AICC staging) and put on palliative che­motherapy consisting of dacarbazine (400mg. I/V daily on Day I-Day 7), adriamycin (60mg I/V on Day I), levamisole (50mg three times daily X 3 days al­ternate week) and interferon a- 2b (9X10 6sub I.U. I/M alternate day X 3 weeks). Following 3 cycles each monthly, the lesion over sole showed no change but a perceptive decrease in the inguinal swelling was noted.

 Discussion



Melanomas of acral lentiginous type show dis­tinct clinical and histologic features that are charac­teristically different from the other commoner vari­ants.[5] Our patient represented a classic case of this relatively new variant characterized clinically by a large macular lentiginous pigmented area around an invasive raised tumour. Histopathologically the lesion exhibited a lentiginous radial growth component, a vertical phase of atypical melanocytes in epitheloid pattern, psoriasiform epidermal hyperplasia and a good host response with focal areas of regression.

The hidden location of lesions, especially over plantar surface contributes to poor prognosis by al­lowing initial lesion to go undetected until the phase of vertical growth occurs. [2] Our patient showed dis­tant metastasis to external iliac lymph nodes with poor prognosis due to its initial benign asymptom­atic appearance and insiduous progress to the inva­sive and metastatic stage. Early detection of the le­sion in the asymptomatic radial growth phase is there­fore critical for better prognosis.

In stage I with involvement of sole, wide ex­cision with 3 cm. margin down to deep fascia re­paired by split thickness grafting suffices. Occasion­ally partial amputation of distal foot with regional lymph node dissection is needed with larger lesions and regional lymph node metastasis. With widespread metastasis, treatment is palliative in the form of che­motherapy with short remissions.[6] Our patient in Stage IV ALM was therefore subjected to combina­tion chemotherapy with no change in the primary lesion, though regression in the size of regional lymph nodes was appreciated at the end of 3 cycles.

References

1Krementz ET, Reed RJ, Coleman WP, et al. Acral lentiginous mela­noma -m a clinicopathologic entity. Ann Surg 1982; 195: 632-645.
2Coleman WP, Loria PR, Reed RJ. Acral lentiginous melanoma. Arch Dermatol 1980; 116: 773-776.
3Ravichandran G, Premlatha S. Pagetoid Melanoma. Indian 3 Dermatol Venereol Leprol 1997; 116: 773-776.
4Chopra A, Walia RLS, Gupta 5, et al. Nodular malignant mela­noma - secondary to carcinoma rectum. Indian J Dermatol Venereol Leprol 1997; 63: 327-329.
5Clark WH, Mihm MC. Lentigo maligna and lentigo maligna mela­noma. Am J Pathol 1969; 55: 39-67.
6Carter S. Dacarbazine. Int J Dermatol 1976; 15: 59-61.

 

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