ACRAL NEVUS

By Gary M. White, MD

Benign acral nevus An oddly-shaped nevus at the base of a toe.


Nevi of the hands and feet and particularly of the palms and soles are distinct for several reasons. First, the thickened skin and dermatoglyphics can give them unique clinical, dermoscopic, and histologic features. Second, the scar from biopsy or complete removal can potentially be problematic from a functional standpoint. These features sometimes lead to delay in diagnosis and misdiagnosis of pigmented acral lesions.

Clinical

Both pigmented and flesh-colored lesions occur. They may be macular or papulonodular. They may be round-to-oval, or oddly-shaped.

Treatment

As usual, any pigmented lesion should be evaluated for melanoma (see abcde and acral melanoma). Any suspicious lesions should be removed entirely and examined histologically.

Additional Pictures

Benign nevi on the dorsal foot and of the palm.
Benign nevi on the dorsal foot Benign nevus on the palm

Benign nevi, both pigmented and non-pigmented, on the toe.
Benign nevus on the toe. A benign, flesh-colored nevus of the toe

A congenital nevus on the finger.
A congenital nevus on the finger A congenital nevus on the finger

A blue nevus on the fingertip.
Blue nevus of the fingertip

Acral melanomas.
Acral melanoma.  Melanoma of the fingertip. Acral melanoma.  Melanoma of the sole.

A blood blister. The key clue here is that the lesion had only appeared 3 days prior.
blood blister

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