Skin Cancer - A World-Wide Perspective by Reinhard Dummer Mark R. Pittelkow Keiji Iwatsuki Adèle Green & Nagwa M. Elwan

Author:Reinhard Dummer, Mark R. Pittelkow, Keiji Iwatsuki, Adèle Green & Nagwa M. Elwan
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

33.2.7 Site-Specific and Meyerson Naevi

33.2.7.1 Acral Naevus

Acral naevi arise on the palms and soles. They are regarded as a separate entity because naevi on these body sites differ significantly from other types of naevi with respect to epidemiology, clinico-dermoscopic appearance and by their relationship to acral lentiginous melanoma.

By contrast to common melanocytic naevi in other locations, there is no clear racial predilection [16]. Acral naevi are present in 3–5% of the Caucasian population and are more commonly found in the second and third decades [33]. Incidences from some studies were higher in dark-skinned races [14], however, without histological confirmation acral naevi may be confounded with volar melanotic macules.

Following the dermatoglyphic pattern of volar skin, acral naevi clinically present as irregular brown macules. Dermoscopy greatly facilitates the differentiation of acral naevi from acral melanoma, whereas, pigment is distributed in the dermal glyphic furrows in benign lesions, it is often accentuated along the dermatoglyphic ridges in melanoma [50].

Besides the typical histopathological features of volar skin, acral naevi often show asymmetry and intraepidermal upward spread of melanocytes, making these lesions facultative melanoma simulators. Severe cytological dysplasia and a dense lymphocytic infiltrate are important clues to the diagnosis of melanoma.

Even if acral naevi share epidemiological findings with acral-lentiginous melanoma, there is yet no indication that any single acral naevus has a higher risk to turn malignant than naevi at other locations. However, regarding their role as risk indicators [23] and in view of the serious prognosis of acral melanoma, regular monitoring of acral naevi is necessary. Excision is recommended if atypical clinical features raise the suspicion of melanoma.

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