Skin melanocytic tumor

Melanocytic tumors on acral skin and nail apparatus

Acral nevus

Topic Completed: 1 January 2017

Minor changes: 9 November 2021

Copyright: 2003-2021,, Inc.

PubMed Search: skin melanocytic tumor acral

Richard E. Horowitz, M.D.
Page views in 2020: 4,323
Page views in 2021 to date: 4,904
Cite this page: Horowitz RE. Acral nevus. website. Accessed November 27th, 2021.
Definition / general
  • Usually defined as nevi of palmar or plantar skin including nailbed
  • Some expand to include nevi of dorsal hands / feet or external ear (Mod Pathol 2006;19:S4)
  • Present in 4 - 9% of population, usually elderly patients
  • May resemble early acral melanoma, although melanomas are rare at these sites
  • Most common location in Asian patients
Clinical features
  • Circumscribed, light brown, not palpable and flat to side lighting
Dermoscopic description
  • Parallel patterns present (Dermatology 2008;216:205); more prominent pigmentation seen in sulci (furrows) of dermatoglyphs, indicative of benign nature
Clinical images

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Various patterns

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Transition pattern

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Various images

Microscopic (histologic) description
  • Histologic overlap exists with melanoma
  • May be junctional, compound or dermal
  • Lentiginous pattern more common than in nevi of non-acral sites
  • Often (61%) low level pagetoid, single cell migration into stratum spinosum (Am J Surg Pathol 1995;19:792), summarized by “MANIAC” (Melanocytic Acral Nevus with Intraepithelial Ascent of Cells)
  • Pagetoid cells should not be atypical and should not be present beyond center of lesion
  • Possible transepidermal elimination of pigment within stratum corneum
  • Nevus cells mature to lesional base
  • May have architectural disorder (J Cutan Pathol 2008;35:889)
Microscopic (histologic) images

Contributed by Angel Fernandez-Flores, M.D., Ph.D.
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Various images

Images hosted on other servers:
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Retraction artifact,
atypia and
pagetoid spread

Differential diagnosis
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