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Acral Melanoma Treatment

Your Guide to Decisions Around Treatment.

When  found early, acral melanoma is usually treated with surgery. The goal is to remove all of the melanoma along with a small amount of healthy skin around it to make sure no cancer cells are left behind, a procedure called a wide local excision The size of the area removed depends on how deep the melanoma goes into the skin. If the tumor is under a nail or has grown deeply, part of the finger or toe may need to be removed to ensure all cancer is gone.

 

If there’s a risk the cancer has spread, doctors may recommend a sentinel lymph node biopsy to check the nearby lymph nodes. This helps determine whether the melanoma has started to move beyond the original site.

Adjuvant Therapy.

After surgery, some patients may be offered adjuvant therapy, additional treatment to lower the risk of the cancer coming back It targets cancer cells that may still be in the body, even if they can’t be seen on scans.

Immunotherapy.

For high-risk cases or when lymph nodes are involved, immunotherapy is commonly used. Immunotherapy helps your immune system find and attack any leftover cancer cells in the body by blocking “brakes” that normally slow it down. Medications like nivolumab and pembrolizumab are examples of this kind of treatment and are often used after surgery for melanoma to help the immune system attack any remaining cancer cells. In some cases, treatment may be given before surgery to shrink the tumor and reduce the risk of spread, this is called neoadjuvant therapy.

Genetic Testing.

Doctors may also recommend  genetic testing of the tumor to better understand how it behaves and guide future treatment decisions.  Ask your care team if genetic testing is right for you.

Breakdown of Treatment Options and Advanced/Metastatic Disease:

There are currently no treatment guidelines developed specifically for acral melanoma, so doctors often follow recommendations for more common types of melanoma. However, acral melanoma has unique features that can affect how it grows and  responds to treatment, which is why a personalized approach  is important.

When the cancer can’t be removed with surgery or has spread, treatment often begins with immunotherapy, especially immune checkpoint inhibitors like pembrolizumab or nivolumab.  In some advanced cases, doctors may recommend a combination of two immunotherapies like nivolumab and ipilimumab to help the immune system respond more strongly.

If acral melanoma spreads to nearby lymph nodes, it is called stage three or regionally advanced melanoma. If it spreads farther to places like the lungs, liver, brain, or other organs, it is considered stage four or metastatic melanoma. At these more advanced stages, treatment focuses on slowing the cancer’s growth, managing symptoms, and helping people live as fully and comfortably as possible. Targeted therapy and radiation may also be part of the plan, especially when surgery isn’t possible or the cancer is in a high-risk area. 

In some cases, doctors recommend genetic testing to guide treatment. If changes in  certain genes, such as BRAF or KIT, are found, targeted therapy may be used.  If a specific BRAF mutation is found, medications like dabrafenib and trametinib may be used together. If certain KIT mutations are present, drugs like imatinib or nilotinib may be tried, though results can vary from person to person.

Clinical Trials 

Acral melanoma foten behaves differently than other types of melanomas, so clinical trials can be an important option to consider. Unlike sun-related melanomas ,  acral melanoma  typically has larger chromosomal changes instead of small DNA mutations,  which can affect how the cancer grows and responds to treatment.

Clinical trials may be especially valuable for people with rare genetic changes, advanced disease, or melanoma that have not responded well to standard treatments. Some studies are exploring newer therapies, such as tumor-infiltrating lymphocyte (TIL) therapy, which uses a person’s own immune cells to fight the cancer or personalized treatments based on a tumor’s genetic or immune profile.

For more information on finding a clinical trial that is right for you, visit the Melanoma Research Foundation’s Clinical Trial Finder. You can also request to be connected with a Clinical Trial Navigator. 

Ongoing research is leading to more targeted treatments and new hope for those facing this rare melanoma subtype.

Sources Used in This Section.

  1. Information adapted from peer-reviewed publications including Acral Melanoma: A Review of Its Pathogenesis, Progression, and Management (PMC), Acral Lentiginous Melanoma – StatPearls (NCBI Bookshelf).

  2. Emerging Strategies to Treat Rare and Intractable Subtypes of Melanoma (PMC), Acral Melanoma: New Insights into the Immune and Genomic Landscape – ScienceDirect, and Tsao H. et al., Review Article, 2023.

  3. This content was also reviewed by acral melanoma expert Dr. Hensin Tsao to ensure accuracy and alignment with current clinical understanding. Updated 2025.