When we think of melanoma, we usually picture moles.
Dark, small, light, circular, irregular – moles can take many shapes and forms, and only some end up being malignant.
But what happens if you can’t see it?
A dangerous subtype of melanoma, acral lentiginous melanoma (ALM), develops on the palms and soles of the feet, and under or around the nails—areas rarely exposed to sunlight. Although overall melanoma rates are lower in Black folks, ALM disproportionately affects them.
According to data from population studies, anywhere from 16–50% or more of melanomas diagnosed in Black patients are ALM. Compare that with just less than five percent in white patients, and the disparity is quite glaring!
Clearly, the myth “Black people don’t get skin cancer” needs to end.
It’s time to set the record straight. Unlike UV-driven melanomas, ALM has distinct biology and risk factors. Let’s discuss the science behind it, how to reduce your risks, how to spot it early, and what to do if you need to take action.
RELATED: Skin Cancer Doesn’t Always Look Like a Mole — Especially on Black Skin
Arising from melanocytes (pigment-producing cells), ALM gets its name from acral sites, or the extremities of the body. It’s in these sites – the palms, soles, and nail units – that the cancer slowly begins. It begins to enlarge, usually in an irregularly pigmented macule or patch. These can be brown, black, gray, or tan, and often with blurred borders that may blend into surrounding skin.
On the soles or palms, it’s like a stain or bruise that doesn’t fade. Under nails, however, ALM appears as a dark longitudinal streak that widens or changes over time, sometimes causing nail splitting or lifting.
Research indicates that a combination of genetic alterations is responsible for this dangerous subtype. Mutations in various pathways, combined with environmental influences, make the risks significantly higher in Black populations.
It should be noted that tumors are often diagnosed as thicker, with ulcerations, with a statistically significant number of acral-site melanomas occurring on the feet.
This is why early detection is so critical.
The first and easiest thing you can do is a self-exam.
In fact, monthly self-exams are the best way to save lives before cancer spreads. Just make sure you use good lighting and a mirror to check your soles and between your toes. Many experts recommend the CUBED rule.
Consider the following:
As you perform your monthly self-exam, make a mental checklist. Firstly, make sure you’re sitting comfortably and examining both palms thoroughly. Don’t miss the sides and in between your fingers.
Then check the soles of your feet, the heels, and the arches. If need be, use a hand mirror or ask for help. After that, inspect the spaces between your toes and the tops/sides of your feet. And finally, examine your nails. Look at every fingernail and toenail for dark streaks, bands that widen at the base, or pigmentation extending to the nail fold.
If you notice any deformities, splitting, or lifting, note them and report them to your doctor. It’s also a good idea to take photos so you can compare sides each month and track changes.
If you start noticing itching, pain, or a lesion that looks like a stubborn callus or bruise, don’t ignore it! On darker skin, pigmentation may appear differently, so don’t dismiss any new or evolving marks. Don’t hesitate to see a dermatologist if you have any questions or concerns. It is always better to be safe than sorry.
Unlike other skin cancers, ALM is not strongly linked to sun exposure. However, that doesn’t mean you should stop protecting your skin. Acral skin is particularly vulnerable to trauma and friction, so always be mindful of any weight on these areas.
The main thing you can do is to wear protective footwear. Choose well-fitting, cushioned shoes that minimize friction and pressure on soles. During activities that involve repetitive hand use, such as sports, gardening, or manual labor, ensure you wear gloves to protect your palms from abrasion. Closed-toe shoes or water shoes are perfect for protecting your feet from cuts.
Next comes the skincare routine. You should be especially focused on keeping your palms and soles moisturized to maintain the integrity of your skin barrier. Remember: dry, cracked skin may be more susceptible to irritation.
As for sunscreen, use a broad-spectrum brand free of harmful synthetic ingredients. Try to find products that explicitly do not contain parabens, phthalates, oxybenzone, octinoxate, and benzophenone-3.
Don’t let your guard down. If you have any persistent sores or non-healing areas on your hands and feet, take them seriously. People with occupations that require long hours and heavy tool use should monitor these areas closely.
The truth is, everyone’s different. When you talk to your doctor, keep this in mind, and know your personal risk factors.
ALM peaks in the 60s, so if you’re 60 or older, you should definitely know that you’re at an elevated risk. ALM, as previously discussed, is also significantly more common in Black, Hispanic, and Asian populations than in white populations.
If you have a family history of melanoma or a personal history of injury and chronic pressure or friction on your palms and soles, you should be extra vigilant. Keep your healthcare provider in the loop.
Prepare questions such as:
If you regularly bring these concerns to your dermatologist visits, you’re well on your way. As always, early biopsy and accurate diagnosis are essential. For most patients, treatment usually starts with a wide surgical excision. For advanced cases, options include immunotherapy, targeted therapy, radiation, and chemotherapy.
But the goal is to never get to that point…
So, stay on top of your health. Keep a watchful eye, don’t obsess, but don’t be negligent either. If something doesn’t look right or you’re just not sure, there’s no shame in asking your doctor. A curious mind for a healthy body!
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