ALM is the Most Common Melanoma in People of Color, But It’s Still Being Overlooked

Acral lentiginous melanoma (ALM) is one of the most common kinds of melanoma for people with darker skin. It’s important to check everywhere for it. Everywhere. Even the places you think see little to no sun, like your underarms, palms, bottoms of your feet, between your toes, and underneath your nails.

That’s not to say that ALM necessarily shows up on the bottoms of feet more than in other places. Rather, it’s an often-overlooked spot, and when ALM is caught early, it’s far less deadly. (More on that in a moment.)

If this is the first you’re hearing of it, ALM is a kind of melanoma that can develop from a pre-existing mole or a new growth. It’s one of the rarest kinds of melanoma, but it’s also one of the deadliest. That’s because it’s usually found in places that typically get skipped in self-skin checks, which can delay the diagnosis.

With all forms of skin cancer, but especially melanoma, early detection is critical because if it’s found while still confined to the outermost layers of the skin, it’s almost always entirely curable. Once it gets thicker and larger, it develops the potential to metastasize, and the cure rate drops dramatically.

The singer Bob Marley died from a melanoma that was found under one of his toenails. It was diagnosed too late because it was initially believed to be a bruise from years of playing soccer.

Why does ALM disproportionately affect people of color?

It’s not totally accurate to say that ALM affects people of color at a greater rate because melanoma, in general, is more common among those with fairer skin. But, when melanoma is found in darker skin tones, the most common kind is ALM.

The keyword there is when. Too often, family doctors don’t prioritize to their patients with darker skin the importance of seeing a board-certified dermatologist for an annual skin check. As a result, skin cancer may not be on their radar. That’s how ALM isn’t diagnosed in many of these patients until it’s more advanced and dangerous.

Why should you be checking between your toes?

The cause of ALM remains a mystery, but it doesn’t appear to stem from sun exposure. Which makes a thorough examination by a board-certified dermatologist all the more important. Self-checks are great, but there are just too many hard-to-reach areas, like behind the ears, on the scalp, and between your toes. Each of those spots appear to be just as vulnerable as anywhere else on the body.

But again, that doesn’t negate the benefits of doming some inspection yourself. It’s just to say that you should make a point of being checked out by a professional at least once a year because early detection makes all the difference.

To aid your search, ALM presents as a hyperpigmented, irregular patch of skin that’s easy to write off as a bruise. If you never noticed it before, continue monitoring it. If it is a bruise, it should fade away within days. If it doesn’t, schedule an appointment with a dermatologist. Similarly, if a mole you’ve had for a while appears to be changing, see a dermatologist. It’s always better to error on the side of caution.