Revised 3-step dermoscopic algorithm for the management of acral melanocytic lesions.

A cral volar skin is the most prevalent site of malignant melanoma in nonwhite populations. In 2007, our group proposed a 3-step algorithm for the management of acquired melanocytic lesions affecting acral volar skin (Figure 1). We now know that almost all acral melanomas arise de novo, not in association with a preexisting acral nevus. Given that an acral nevus has virtually no risk of developing to acral melanoma, follow-up of a definitely diagnosed acral nevus is not necessary. Taking this point into account, we have revised the 3-step algorithm. In the revised algorithm, the order of the second and the third steps in the previous algorithm is reversed, and a new category without need of further follow-up is introduced.