TREATMENT OF ACRAL LENTIGINOUS MELANOMA (ALM)

Following biopsy-confirmed ALM by a pathologist, the treatment of ALM is typically handled by a dermatologist or oncologist.

Generally, ALM in-situ is best treated with a wide local excision. The surgical margin recommendations are based on the tumor thickness at the time of biopsy. 

If metastases are detected, systemic treatment with chemotherapeutic agents, targeted mutational therapy, and immune checkpoint inhibitors may be indicated.3 Nonsurgical treatment decisions should be made through referral to an oncologist.

Referrals  

Depending on the diagnosis, patients should be referred to different specialists for treatment: 

• To a dermatologist, if the pathologist report reveals Stages 0, 1, or 2 melanoma. 

• To a medical oncologist, if pathology reports reveal stages IIB or IIC melanoma. 
• In addition, referral to dermatology may be appropriate when a second opinion is needed:14 

• If the patient would benefit from dermoscopy and a clinician is unable to perform it 
• If a clinician is unsure whether a lesion should be biopsied 
• If a clinician does not feel comfortable performing the biopsy 

• Patient preference