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Current Treatment Options in Oncology
Published in: Current Treatment Options in Oncology 8/2018

01-08-2018 | Skin Cancer (T Ito, Section Editor)

Diagnosis and Management of Acral Lentiginous Melanoma

Authors: Yoshiyuki Nakamura, MD, PhD, Yasuhiro Fujisawa, MD, PhD

Published in: Current Treatment Options in Oncology | Issue 8/2018

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Opinion statement

Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.
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Metadata
Title
Diagnosis and Management of Acral Lentiginous Melanoma
Authors
Yoshiyuki Nakamura, MD, PhD
Yasuhiro Fujisawa, MD, PhD
Publication date
01-08-2018
Publisher
Springer US
Published in
Current Treatment Options in Oncology / Issue 8/2018
Print ISSN: 1527-2729
Electronic ISSN: 1534-6277
DOI
https://doi.org/10.1007/s11864-018-0560-y

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