By Gary M. White, MD

Acral Melanoma

A melanoma that occurs on the digits, hands, or feet has been called an acral melanoma. It is the least common of the major types, but the most common in darker-skinned patients. The term acral lentiginous melanoma is a subtype of acral melanoma in which atypical melanocytes proliferate along the dermal epidermal junction in a diffuse lentiginous fashion.


In general, the ABCDE criteria for pigmented lesions applies to the acral areas as well. The dermatoscopic BRAAFF checklist has been suggested for use in the diagnosis of acral melanoma [BJD 2015;173, 1041–1049].

Acronym Criteria Points
B Irregular blotch +1
R Parallel ridge pattern +3
A Asymmetry of structures +1
A Asymmetry of colors +1
F Parallel furrow pattern -1
F Fibrillar pattern -1

A total score of ≥ 1 is needed for a diagnosis of melanoma.

Additional Pictures

Acral Melanoma Acral Melanoma Acral Melanoma Acral Melanoma

Recurrent on the nail.
Acral Melanoma

Melanoma on the sole.
Acral Melanoma Acral Melanoma

Acral Melanoma

Melanoma in situ of the sole
Melanoma in situ of the sole


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