Acral Melanoma Fact Sheet FAST FACTS: • Acral melanoma is a rare skin cancer that starts on the palms, soles or under fingernails/toenails. • It makes up 1–3% of U.S. melanoma cases (~2,000–3,000 per year). • Acral melanoma is the most common melanoma subtype in Black, Asian, and Hispanic individuals, but can affect anyone. • Not caused by UV exposure. • Often diagnosed later due to limited access to care, low awareness or lack of insurance. What It Can Look Like • May resemble a dark nail streak, bruise, callus, wart or fungal infection. • A biopsy is needed to confirm diagnosis.
CUBED: Know the Signs
C U B E D
COLOR Uneven or unusual color (brown, black, gray, multicolored).
UNCERTAIN CAUSE No clear reason or injury.
BLEEDING Especially under nails or on the foot.
ENLARGEMENT Growing or changing spot.
• Dermoscopy may reveal a “parallel ridge pattern.” • Imaging studies (such as MRI, CT, or PET scans) may be used in certain cases.
DELAY Not healing after 2+ months.
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Treatment Basics • S urgery is the main treatment for early-stage disease.
• M ay include wide excision or in some cases, partial finger/toe removal. • L ymph node biopsy (a procedure that checks nearby lymph nodes for signs of melanoma) may be done to check for spread.
Advanced Treatment Options • Immunotherapy (e.g., nivolumab, pembrolizumab) is often used after or before surgery. • T argeted therapy may be an option if BRAF or KIT genetic mutations are found. • R adiation may help in select cases. • A cral melanoma has unique genetic changes and may respond differently than UV-related melanoma. • T umor-infiltrating lymphocyte (TIL) therapy is a newer treatment option that may be available for some patients.
Clinical Trials & Next Steps • N o treatment guidelines exist specifically for acral melanoma — care should be personalized. • S earch current acral melanoma trials.
What You Can Do • C heck your hands, feet and nails regularly. • S peak up about any new, changing or slow- to-heal spots. • G et it checked — early detection saves lives!
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UPDATED FEBRUARY 2026
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