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The Misdiagnosis of Acral Lentiginous Melanoma: Three Case Presentations

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  • 1 The Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
  • | 2 New York College of Podiatric Medicine, New York, NY. Dr. Stowers is now with MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC. Dr. Black is now with Lenox Hill Hospital Northwell, New York, NY. Dr. Saccomanno is now with Hungtington Hospital at Northwell Health, Huntington, NY.
  • | 3 Departments of Pathology and Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Acral lentiginous melanoma (ALM) is a disease that is found on the palms, soles, and nail beds. Because these areas are not often examined during general medical examinations, the presence of ALM often goes unnoticed or the diagnosis is delayed. Research shows that the misdiagnosis of ALM is common, reported between 20% and 34%. We present three cases of ALM that were initially misdiagnosed and referred to the senior author (B.C.M.) in an effort to assess why misdiagnosis is common. The existing literature illuminates clinical pitfalls in diagnosing ALM. The differential diagnosis of many different podiatric skin and nail disorders should include ALM. Although making the correct diagnosis is essential, the prognosis is affected by the duration of the disease and level of invasiveness. Unfortunately, most of the reported misdiagnosed cases are of a later stage and worse prognosis. This review highlights that foot and ankle specialists should meet suspect lesions with a heightened index of suspicion and perform biopsy when acral nonhealing wounds and/or lesions are nonresponsive to treatment.

Corresponding author: Bryan C. Markinson, DPM, ABPM, The Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 17 E 102nd St, New York, NY 10029. (E-mail: bryan.markinson@mountsinai.org)