Acral and Nail Melanoma.

Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous malignant melanoma not linked to UV exposure that carries a poor survival prognosis. ALM is defined by its acral location, involving the palms, soles, and subungual regions of the hands and feet, as well as by its unique clinical characteristics. We have reviewed the incidence, diagnostic standards, histopathology, dermatoscopic features, reflectance confocal microscopy features, genomic alterations, and treatment of ALM. In addition, several recent case reports are highlighted that showcase the diagnostic challenge that ALM can pose and the barriers to arriving at a prompt, accurate ALM diagnosis. Increased patient and provider education, empowering early detection and treatment, as well as the development of new more targeted therapeutics are critical to improving ALM outcomes.