Last fall, University of Kentucky football fans got an unexpected education in a rare and deadly form of skin cancer called acral melanoma.  Wildcats fans cheered during the last home game of the 2018 season when 20-year old Josh Paschal checked in on the defense for the first time in his sophomore year. He’d been sidelined since August after discovering what he thought was a blood blister on the sole of his right foot. The darkened spot, about the size of a dime, turned out to be acral lentiginous melanoma (ALM). Josh endured three surgeries, immunotherapy and rigorous rehabilitation to get back on the field.

Being black, Josh said he never thought he’d be susceptible to any type of melanoma. “I’m definitely looking at my skin more now,” he told reporters recently. In fact, ALM is the most common form of skin cancer affecting blacks.

ALM is a specific type of melanoma that develops on the palms of the hands, soles of the feet and under the nails. It usually presents as a dark brown or black lesion on the skin or a pigmented streak under the nail. Although it accounts for only about 5% of all melanomas, it represents 33% of melanomas in dark-skinned people, like those of Asian or African-American descent. There are no known risk factors. ALM has a higher death rate than other forms of melanoma, likely because it is most often diagnosed at a more advanced stage. Treatment of ALM is similar to other forms of melanoma, usually beginning with surgery to remove the mass and surrounding tissue as well as to check for cancerous spread to surrounding lymph nodes.

With so little known about what causes this cancer, research is especially vital.  A team of Moffitt researchers led by Dr. Keiran Smalley, director of the Donald A. Adams Melanoma and Skin Cancers Center of Excellence, was recently awarded a $900,000 grant from the Melanoma Research Alliance. Over the next three years, Moffitt’s team will utilize its diverse skills to explore the mechanisms underlying the development of ALM and identify potential targets for new forms of therapy. As part of the grant, researchers will look at the genetic makeup of benign tumors that develop on soles, palms or nailbeds. It’s possible these tumors may be precursors of melanoma, and comparing them to actual ALM tumors could further our understanding of the disease. Moffitt’s research will also involve creation of cell lines and use of mouse models to mimic the development and spread of tumors, and enable investigators to study the effects of therapeutic targeting of molecules identified that may cause this tumor.

In the meantime, early detection is the key to surviving ALM. Don’t forget your palms, soles and nails as you monitor your skin for any changes that could signal cancer.  Dark, irregular spots on this skin or any streaks under the fingernail or toenail should be brought to the attention of your physician or dermatologist.