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.
Read more about this topic: Acral Lentiginous Melanoma