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Acral Melanoma — SCE Dermatology MCQ

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HardSkin CancerAcral MelanomaSCE Dermatology

A new 9-mm plantar macule shows asymmetry, irregular diffuse pigmentation and a parallel-ridge pattern on dermoscopy. What is the most defensible diagnostic action?

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Correct answer: B — Perform complete diagnostic excision and submit the lesion for histology

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

C is correct. Pigment following acral ridges, particularly with asymmetry and irregular diffuse pigmentation, is strongly suspicious for acral melanoma. Definitive tissue diagnosis should not be delayed by prolonged monitoring or empirical treatment. Complete diagnostic excision with a narrow margin is preferred where feasible; the approach is adapted on a weight-bearing site to preserve interpretable architecture and permit Breslow measurement. Paring can help identify superficial haemorrhage but does not safely negate malignant dermoscopic features. Curettage destroys the architecture needed for diagnosis and staging.

Reference: Clinical and Experimental Dermatology: acral lentiginous melanoma review: https://academic.oup.com/ced/article/51/6/967/8321411