Introduction: Acral lentiginous melanoma (ALM), a rare subtype, accounts for 2–3% of melanoma cases, primarily affecting the palms, soles, and nail beds and disproportionately affects people of color. This review focuses on clinical insights into ALM and its management, with a focus on race and ethnicity.Methods: A comprehensive literature search was conducted in public databases using the search term “acral melanoma,” and studies focusing on epidemiology, clinical presentation, and treatment outcomes of ALM in various racial and ethnic groups were reviewed.Results: Significant disparities in ALM outcomes exist across racial and ethnic groups, with African, Hispanic, and Asian individuals presenting with thicker, more advanced tumors at diagnosis. These populations encounter unique challenges, including limited access to dermatologic care, under-recognition of melanoma presentation in darker skin types, and socioeconomic barriers leading to delayed diagnosis and treatment. Surgical management may require specialized approaches, such as partial amputation for subungual melanomas. Additionally, there is uncertainty regarding the tumor immune microenvironment (TME) in ALM, with some studies suggesting that it might be less favorable, resulting in a lower response to immunotherapy.Conclusions: ALM affects diverse populations, and the impact of ethnic and racial origin on ALM biology is largely unknown. Addressing disparities in ALM outcomes among racial and ethnic groups is critical for improving patient care. Increased awareness of melanoma risk in individuals with darker skin can significantly impact early detection and treatment. Future research should focus on the genetic and biological factors contributing to morbidity and mortality in ALM patients.
引言：肢端雀斑样黑色素瘤（ALM）是一种罕见亚型，占黑色素瘤病例的2-3%，主要累及手掌、足底及甲床，且在有色人种中发病率显著偏高。本综述聚焦于ALM的临床特征及其诊疗策略，特别关注种族与民族因素的影响。 方法：通过公共数据库以“肢端黑色素瘤”为检索词进行系统性文献检索，重点分析不同种族和民族群体中ALM的流行病学特征、临床表现及治疗结局的相关研究。 结果：不同种族与民族群体间存在显著的ALM预后差异，非洲裔、西班牙裔和亚洲裔患者在确诊时往往呈现更厚、更晚期的肿瘤特征。这些群体面临独特挑战，包括皮肤科诊疗资源可及性有限、深肤色人群黑色素瘤表现认知不足，以及社会经济障碍导致的诊断与治疗延迟。手术治疗可能需要特殊方案，例如甲下黑色素瘤的部分截肢术。此外，ALM的肿瘤免疫微环境特征尚不明确，部分研究表明其免疫微环境可能不利于治疗，导致对免疫疗法的反应率较低。 结论：ALM影响多样化人群，而种族与民族因素对其生物学特性的影响机制尚未明确。解决不同种族和民族群体间的ALM预后差异对改善患者护理至关重要。提高对深肤色人群黑色素瘤风险的认识，将显著影响早期发现和治疗效果。未来研究应重点关注导致ALM患者发病率和死亡率的遗传与生物学因素。
Acral Melanoma in Skin of Color: Current Insights and Future Directions: A Narrative Review
肿瘤(癌症)患者之家