WordNet

any of several malignant neoplasms (usually of the skin) consisting of melanocytes (同)malignant_melanoma

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/10 21:39:01」(JST)

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Acral lentiginous melanoma is a kind of lentiginous^[1] skin melanoma.^[2]^:695

About 1 to 3% of melanomas in Australia and New Zealand are acral lentiginous melanoma. Melanoma is a potentially serious skin cancer that arises from pigment cells (melanocytes). Although acral lentiginous melanoma is rare in Caucasians and people with lighter skin types, it is the most common subtype in people with darker skins. Acral lentiginous melanoma is observed on the palms, soles, under the nails and in the oral mucosa.^[3] It occurs on non hair-bearing surfaces of the body which may or may not be exposed to sunlight. It is also found on mucous membranes. Unlike other forms of melanoma, acral lentiginous melanoma does not appear to be linked to sun exposure.

It is the most common form of melanoma diagnosed amongst Asian and Black ethnic groups.^{[citation needed]} The average age at diagnosis is between sixty and seventy years.^{[citation needed]} However, the melanoma can also occur in White ethnic groups and in young people.^{[citation needed]}

Diagnosis

Even though the ideal method of diagnosis of melanomas should be complete excisional biopsy, the location of the melanoma may require alternatives.

Dermatoscopy of acral pigmented lesions is very difficult, but can be accomplished with diligent attention.

Initial confirmation of the suspicion can be done with a small wedge biopsy or small punch biopsy. Thin deep wedge biopsies can heal very well on acral skin, and small punch biopsies can give enough clue to the malignant nature of the lesion. Once this confirmatory biopsy is done, a second complete excisional skin biopsy can be performed with a narrow surgical margin (1 mm). This second biopsy will determine the depth and invasiveness of the melanoma, and will help to define what the final treatment will be. If the melanoma involves the nail fold and the nail bed, complete excision of the nail unit might be required.

Final treatment might require wider excision (margins of 0.5 cm or more), digital amputation, lymphangiogram with lymph node dissection, or chemotherapy.

Signs and symptoms

Typical signs of acral lentiginous melanoma include^{[citation needed]}:

longitudinal tan, black, or brown streak on a finger or toe nail (melanonychia striata)
pigmentation of proximal nail fold
areas of dark pigmentation on palms of hands or soles of feet

Warning signs are new areas of pigmentation, or existing pigmentation that shows change.^{[citation needed]} If caught early, acral lentiginous melanoma has a similar cure rate as the other types of superficial spreading melanoma.^{[citation needed]}

Histology

Histological signs of acral lentiginous melanoma include:

atypical melanocytes arranged singly and in junctional nests
dermal invasion
desmoplasia

Famous case

Bob Marley's death was caused by acral lentiginous melanoma present under one of his toenails.^[4]

References

^ Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L (August 2007). "Acral lentiginous melanoma: histopathological prognostic features of 121 cases". Br. J. Dermatol. 157 (2): 311–8. doi:10.1111/j.1365-2133.2007.08031.x. PMID 17596173.
^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
^ Krementz ET, Feed RJ, Coleman WP, Sutherland CM, Carter RD, Campbell M (May 1982). "Acral lentiginous melanoma. A clinicopathologic entity". Ann. Surg. 195 (5): 632–45. doi:10.1097/00000658-198205000-00013. PMC 1352575. PMID 7073361.
^ "His story: The life and legacy of Bob Marley". web.bobmarley.com. Retrieved October 4, 2009.

External links

Histology
GP Notebook
http://www.dermnetnz.org/lesions/alm.html

UpToDate Contents

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1. 黒色腫の病理学的特徴 pathologic characteristics of melanoma
2. 黒色腫の皮膚検査および臨床的特徴 skin examination and clinical features of melanoma
3. 皮膚黒色腫におけるtumor node metastasis（TNM）病期分類法
およびその他の予後因子 tumor node metastasis tnm staging system and other prognostic factors in cutaneous melanoma
4. 手掌および足底の色素性病変のダーモスコピー dermoscopy of pigmented lesions of the palms and soles
5. 爪疾患の概要 overview of nail disorders

English Journal

Subungual melanoma: An important tip.

Miranda BH, Haughton DN, Fahmy FS.SourcePlastic & Reconstructive Surgery Department, Countess of Chester Hospital NHS Foundation Trust, Countess of Chester Health Park, Liverpool Road, Chester CH2 1UL, UK. Electronic address: DrBMiranda@googlemail.com.
Journal of plastic, reconstructive & aesthetic surgery : JPRAS.J Plast Reconstr Aesthet Surg.2012 Oct;65(10):1422-4. doi: 10.1016/j.bjps.2012.03.001. Epub 2012 Mar 23.
Acral lentiginous melanoma is rare, representing approximately 1% of malignant melanomas. Overall 5 year survival is disproportionately poor (25-51%) compared to other histological subtypes. This has been attributed to diagnostic delay resulting in more advanced presentation. Subungual presentation
PMID 22445692

Unique prognostic factors in acral lentiginous melanoma.

Egger ME, McMasters KM, Callender GG, Quillo AR, Martin RC 2nd, Stromberg AJ, Scoggins CR.SourceDepartment of Surgery, Division of Surgical Oncology, University of Louisville, 315 East Broadway, Suite 303, Louisville, KY 40202, USA.
American journal of surgery.Am J Surg.2012 Sep 27. pii: S0002-9610(12)00446-1. doi: 10.1016/j.amjsurg.2012.05.013. [Epub ahead of print]
BACKGROUND: This study was performed to identify clinicopathologic factors associated with survival in acral lentiginous melanoma.METHODS: A post hoc analysis of a prospective clinical trial and local database was performed in all patients with acral lentiginous melanomas. Multivariate analyses of f
PMID 23022254

Japanese Journal

外腸骨動脈周囲にセンチネルリンパ節を認めた末端黒子型黒色腫の1例 (特集悪性黒色腫)

楠山太郎,爲政大幾,田嶋安紀 [他]
皮膚科の臨床 56(1), 31-36, 2014-01
NAID 40019939743

左母趾を温存して原発巣を切除した左足底悪性黒色腫の1例

平林恵,帆足俊彦,中島広子,五十棲健
Skin Cancer 28(3), 274-278, 2014
70歳代，男性。2，3年前左足底に黒色斑が出現した。初診時，左足底母趾基部に20×18mm大の色調不均一な黒色斑があり，その近傍に小黒色斑を二つ有し，主病変の皮表は過角化を来たしていた。左鼠径部に固い皮下腫瘤を二つ触れ，PET－CTでは左鼠径リンパ節転移が疑われた。衛星病巣，左鼠径リンパ節転移を伴う左足底悪性黒色腫と診断し，原発巣，衛星病巣をマージン1～2 cmで切除した。右足底からの植皮で再建し …
NAID 130004697515

ダーモスコピーで良性病変を示唆し，病理組織でメラノーマとの鑑別に苦慮した足底の非定型的色素性母斑（pseudomelanoma）の1例

中村考伸,出光俊郎,塚原理恵子,小山尚俊,中村哲史,飯田絵理,正木真澄,梅本尚可,加倉井真樹,山田朋子,堂本隆志,中川秀己,伊東慶悟
Skin Cancer 27(3), 350-354, 2013
… 臨床的にはmelanoma in situを疑う所見であったが，ダーモスコピーでは良性病変を示唆する結果であり，切除生検を施行した。 … 病理組織では表皮内にメラノサイトが孤立性，あるいは胞巣を形成し，一部は付属器浸潤もみられるなどmelanoma in situの可能性が否定できず，切除瘢痕辺縁から5 mm離して，再切除を施行した。 …
NAID 130003378150

Related Pictures

★リンクテーブル★

リンク元	「悪性黒色腫」「末端黒子型黒色腫」
関連記事	「acral」「lentiginous」

「悪性黒色腫」

Acral lentiginous melanoma
	Classification and external resources
ICD-10	C43 (ILDS C43.L60)
ICD-9	172.0-173.9
ICD-O:	M8744/3

　　[★]

英: malignant melanoma MM
同: メラノーマ melanoma
ラ: melanoma malignum
関: メラニン尿

概念

メラノサイト(神経堤由来)が癌化した悪性腫瘍
色調は多くが黒褐色。紅色調病変もありうる(無色素性黒色腫 amelanotic melanoma)　←　メラニン合成能の喪失
転移能しやすい。予後不良。　→　リンパ行性が最も頻度が高い・・・だっけ？
原発：皮膚。粘膜(口腔、鼻腔)、脈絡膜、脳軟膜、眼もありうる。

悪性黒色腫のABCDE NDE.421

頭文字	特徴
A	Asymmetry	不規則形
B	Borderline irregularity	境界不鮮明
C	Color variegation	色調多彩
D	Diameter enlargement	拡大傾向(直径6mm以上)
E	Elevation of surface	表面隆起