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Dermoscopy of pigmented lesions of the palms and soles

Toshiaki Saida, MD, PhD
Hiroshi Koga, MD
Section Editor
Hensin Tsao, MD, PhD
Deputy Editor
Rosamaria Corona, MD, DSc


In populations with darker skin, melanoma occurs most frequently in acral areas, with a particular predilection for the soles of the feet. In Japanese, almost one-half of cutaneous melanomas occur in acral areas and approximately 30 percent affect the sole [1]. The prognosis of acral melanoma is generally poor, mainly as a consequence of a delay in diagnosis [2,3]. Dermoscopy, a noninvasive technique performed by a handheld instrument called a dermatoscope, increases the clinician’s diagnostic accuracy for pigmented lesions of the palms and soles and may help in the recognition of acral melanoma at an early, curable stage [4,5].

This topic will review the dermoscopic features of melanocytic and nonmelanocytic pigmented lesions of the palms and soles and the dermoscopic criteria for differentiating benign melanocytic nevi from early melanoma. The principles of dermoscopy and the use of dermoscopy for the evaluation of pigmented lesion located on the nonglabrous skin, face, mucosal surfaces, and nails are discussed separately. Dermoscopic algorithms for skin cancer triage are also discussed separately.

(See "Overview of dermoscopy".)

(See "Dermoscopic evaluation of skin lesions".)

(See "Dermoscopy of facial lesions".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 28, 2015.
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  1. Ishihara K, Saida T, Otsuka F, et al. Statistical profiles of malignant melanoma and other skin cancers in Japan: 2007 update. Int J Clin Oncol 2008; 13:33.
  2. Durbec F, Martin L, Derancourt C, Grange F. Melanoma of the hand and foot: epidemiological, prognostic and genetic features. A systematic review. Br J Dermatol 2012; 166:727.
  3. Bradford PT, Goldstein AM, McMaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005. Arch Dermatol 2009; 145:427.
  4. Saida T, Oguchi S, Miyazaki A. Dermoscopy for acral pigmented skin lesions. Clin Dermatol 2002; 20:279.
  5. Saida T, Koga H, Uhara H. Key points in dermoscopic differentiation between early acral melanoma and acral nevus. J Dermatol 2011; 38:25.
  6. Nagashima Y, Akita M, Tsuchida T. Relationship between the three-dimensional structure of the human plantar epidermis and the dermoscopic patterns seen in melanocytic nevi. Dermatology 2011; 222:67.
  7. Signoretti S, Annessi G, Puddu P, Faraggiana T. Melanocytic nevi of palms and soles: a histological study according to the plane of section. Am J Surg Pathol 1999; 23:283.
  8. Ishihara Y, Saida T, Miyazaki A, et al. Early acral melanoma in situ: correlation between the parallel ridge pattern on dermoscopy and microscopic features. Am J Dermatopathol 2006; 28:21.
  9. Saida T, Koga H, Goto Y, Uhara H. Characteristic distribution of melanin columns in the cornified layer of acquired acral nevus: an important clue for histopathologic differentiation from early acral melanoma. Am J Dermatopathol 2011; 33:468.
  10. Saida T, Oguchi S, Ishihara Y. In vivo observation of magnified features of pigmented lesions on volar skin using video macroscope. Usefulness of epiluminescence techniques in clinical diagnosis. Arch Dermatol 1995; 131:298.
  11. Oguchi S, Saida T, Koganehira Y, et al. Characteristic epiluminescent microscopic features of early malignant melanoma on glabrous skin. A videomicroscopic analysis. Arch Dermatol 1998; 134:563.
  12. Palicka GA, Rhodes AR. Acral melanocytic nevi: prevalence and distribution of gross morphologic features in white and black adults. Arch Dermatol 2010; 146:1085.
  13. Kogushi-Nishi H, Kawasaki J, Kageshita T, et al. The prevalence of melanocytic nevi on the soles in the Japanese population. J Am Acad Dermatol 2009; 60:767.
  14. Saida T, Miyazaki A, Oguchi S, et al. Significance of dermoscopic patterns in detecting malignant melanoma on acral volar skin: results of a multicenter study in Japan. Arch Dermatol 2004; 140:1233.
  15. Yamaura M, Takata M, Miyazaki A, Saida T. Specific dermoscopy patterns and amplifications of the cyclin D1 gene to define histopathologically unrecognizable early lesions of acral melanoma in situ. Arch Dermatol 2005; 141:1413.
  16. Malvehy J, Puig S. Dermoscopic patterns of benign volar melanocytic lesions in patients with atypical mole syndrome. Arch Dermatol 2004; 140:538.
  17. Altamura D, Altobelli E, Micantonio T, et al. Dermoscopic patterns of acral melanocytic nevi and melanomas in a white population in central Italy. Arch Dermatol 2006; 142:1123.
  18. Saida T, Koga H. Dermoscopic patterns of acral melanocytic nevi: their variations, changes, and significance. Arch Dermatol 2007; 143:1423.
  19. Miyazaki A, Saida T, Koga H, et al. Anatomical and histopathological correlates of the dermoscopic patterns seen in melanocytic nevi on the sole: a retrospective study. J Am Acad Dermatol 2005; 53:230.
  20. Maumi Y, Kimoto M, Kobayashi K, et al. Oblique view dermoscopy changes regular fibrillar pattern into parallel furrow pattern. Dermatology 2009; 218:385.
  21. Ozdemir F, Karaarslan IK, Akalin T. Variations in the dermoscopic features of acquired acral melanocytic nevi. Arch Dermatol 2007; 143:1378.
  22. Minagawa A, Koga H, Saida T. Dermoscopic characteristics of congenital melanocytic nevi affecting acral volar skin. Arch Dermatol 2011; 147:809.
  23. Zalaudek I, Zanchini R, Petrillo G, et al. Dermoscopy of an acral congenital melanocytic nevus. Pediatr Dermatol 2005; 22:188.
  24. Garrido-Ríos AA, Carrera C, Puig S, et al. Homogeneous blue pattern in an acral congenital melanocytic nevus. Dermatology 2008; 217:315.
  25. Fargnoli MC, Suppa M, Micantonio T, et al. Dermoscopic features and follow-up changes of acral melanocytic naevi in childhood and adolescence. Br J Dermatol 2014; 170:374.
  26. Minagawa A, Koga H, Uhara H, et al. Age-related prevalence of dermoscopic patterns in acquired melanocytic nevus on acral volar skin. JAMA Dermatol 2013; 149:989.
  27. Suzaki R, Ishizaki S, Iyatomi H, Tanaka M. Age-related prevalence of dermatoscopic patterns of acral melanocytic nevi. Dermatol Pract Concept 2014; 4:53.
  28. Saida T, Kawachi S, Koga H. Anatomic transitions and the histopathologic features of melanocytic nevi. Arch Dermatol 2008; 144:1232.
  29. Kawabata Y, Tamaki K. Distinctive dermatoscopic features of acral lentiginous melanoma in situ from plantar melanocytic nevi and their histopathologic correlation. J Cutan Med Surg 1998; 2:199.
  30. Kolm I, Kamarashev J, Kerl K, et al. Acral melanoma with network pattern: a dermoscopy-reflectance confocal microscopy and histopathology correlation. Dermatol Surg 2010; 36:701.
  31. Braun RP, Thomas L, Dusza SW, et al. Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society. Dermatology 2013; 227:373.
  32. Phan A, Touzet S, Dalle S, et al. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol 2006; 155:561.
  33. Phan A, Dalle S, Touzet S, et al. Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol 2010; 162:765.
  34. Nogita T, Wong TY, Ohara K, et al. Atypical melanosis of the foot. A report of three cases in Japanese populations. Arch Dermatol 1994; 130:1042.
  35. Kwon IH, Lee JH, Cho KH. Acral lentiginous melanoma in situ: a study of nine cases. Am J Dermatopathol 2004; 26:285.
  36. Kilinc Karaarslan I, Akalin T, Unal I, Ozdemir F. Atypical melanosis of the foot showing a dermoscopic feature of the parallel ridge pattern. J Dermatol 2007; 34:56.
  37. Chiu HH, Hu SC, Ke CL, Cheng ST. Dermoscopy identifies histopathologically indiscernible malignant lesion of atypical melanosis of the foot, an early lesion of acral lentiginous melanoma in situ. Dermatol Surg 2008; 34:979.
  38. Oh TS, Bae EJ, Ro KW, et al. Acral Lentiginous Melanoma Developing during Long-standing Atypical Melanosis: Usefulness of Dermoscopy for Detection of Early Acral Melanoma. Ann Dermatol 2011; 23:400.
  39. Kim JY, Choi M, Jo SJ, et al. Acral lentiginous melanoma: indolent subtype with long radial growth phase. Am J Dermatopathol 2014; 36:142.
  40. Koga H, Saida T. Revised 3-step dermoscopic algorithm for the management of acral melanocytic lesions. Arch Dermatol 2011; 147:741.
  41. Saida T, Yoshida N, Ikegawa S, et al. Clinical guidelines for the early detection of plantar malignant melanoma. J Am Acad Dermatol 1990; 23:37.
  42. Braun RP, Thomas L, Kolm I, et al. The furrow ink test: a clue for the dermoscopic diagnosis of acral melanoma vs nevus. Arch Dermatol 2008; 144:1618.
  43. Uhara H, Koga H, Takata M, Saida T. The whiteboard marker as a useful tool for the dermoscopic "furrow ink test". Arch Dermatol 2009; 145:1331.
  44. Saida T. Lessons learned from studies of the development of early melanoma. Int J Clin Oncol 2005; 10:371.
  45. Takata M, Murata H, Saida T. Molecular pathogenesis of malignant melanoma: a different perspective from the studies of melanocytic nevus and acral melanoma. Pigment Cell Melanoma Res 2010; 23:64.
  46. Altamura D, Zalaudek I, Sera F, et al. Dermoscopic changes in acral melanocytic nevi during digital follow-up. Arch Dermatol 2007; 143:1372.
  47. Lallas A, Kyrgidis A, Koga H, et al. The BRAAFF checklist: a new dermoscopic algorithm for diagnosing acral melanoma. Br J Dermatol 2015; 173:1041.
  48. Tanioka M. Benign acral lesions showing parallel ridge pattern on dermoscopy. J Dermatol 2011; 38:41.
  49. Urbina F, León L, Sudy E. Black heel, talon noir or calcaneal petechiae? Australas J Dermatol 2008; 49:148.
  50. Zalaudek I, Argenziano G, Soyer HP, et al. Dermoscopy of subcorneal hematoma. Dermatol Surg 2004; 30:1229.
  51. Robertson SJ, Leonard J, Chamberlain AJ. PlayStation purpura. Australas J Dermatol 2010; 51:220.
  52. Bernabeu-Wittel J, Domínguez-Cruz J, Zulueta T, et al. Hemorrhagic parallel-ridge pattern on dermoscopy in "Playstation fingertip". J Am Acad Dermatol 2011; 65:238.
  53. Fukushima S, Hatta N. Atypical moles in a patient undergoing chemotherapy with oral 5-fluorouracil prodrug. Br J Dermatol 2004; 151:698.
  54. Paravar T, Hymes SR. Longitudinal melanonychia induced by capecitabine. Dermatol Online J 2009; 15:11.
  55. Villalón G, Martín JM, Pinazo MI, et al. Focal acral hyperpigmentation in a patient undergoing chemotherapy with capecitabine. Am J Clin Dermatol 2009; 10:261.
  56. Campos-Muñoz L, Pedraz-Muñoz J, Conde-Taboada A, Lopez-Bran E. Dermoscopy of Peutz-Jeghers syndrome. J Eur Acad Dermatol Venereol 2009; 23:730.
  57. Sendagorta E, Feito M, Ramírez P, et al. Dermoscopic findings and histological correlation of the acral volar pigmented maculae in Laugier-Hunziker syndrome. J Dermatol 2010; 37:980.
  58. Gencoglan G, Gerceker-Turk B, Kilinc-Karaarslan I, et al. Dermoscopic findings in Laugier-Hunziker syndrome. Arch Dermatol 2007; 143:631.
  59. Chapel TA, Taylor RM, Pinkus H. Volar melanotic macules. Int J Dermatol 1979; 18:222.
  60. Blossom J, Altmayer S, Jones DM, et al. Volar melanotic macules in a gardener: a case report and review of the literature. Am J Dermatopathol 2008; 30:612.
  61. Martín RF, Sánchez JL, Vázquez-Botet M, Lugo A. Pigmented macules on palms and soles in Puerto Ricans. Int J Dermatol 1994; 33:418.
  62. Ashida M, Ueda M, Kunisada M, et al. Protean manifestations of human papillomavirus type 60 infection on the extremities. Br J Dermatol 2002; 146:885.
  63. Arpaia N, Filotico R, Mastrandrea V, et al. Acral viral wart showing a parallel ridge pattern on dermatoscopy. Eur J Dermatol 2009; 19:381.
  64. Tanioka M, Nakagawa Y, Maruta N, Nakanishi G. Pigmented wart due to human papilloma virus type 60 showing parallel ridge pattern in dermoscopy. Eur J Dermatol 2009; 19:643.
  65. Dalmau J, Abellaneda C, Puig S, et al. Acral melanoma simulating warts: dermoscopic clues to prevent missing a melanoma. Dermatol Surg 2006; 32:1072.
  66. Piliouras P, Allison S, Rosendahl C, et al. Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases. Australas J Dermatol 2011; 52:191.
  67. Tanioka M, Matsumura Y, Utani A, et al. Occupation-related pigmented macules on the sole with parallel-ridge pattern on dermatoscopy. Clin Exp Dermatol 2009; 34:e31.
  68. Lacarrubba F, Dall'oglio F, Dinotta F, Micali G. Photoletter to the editor: Exogenous pigmentation of the sole mimicking in situ acral melanoma on dermoscopy. J Dermatol Case Rep 2012; 6:100.
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