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Health condition

Acral and mucosal melanoma

Acral melanoma arises on the palms, soles and under nails, and mucosal melanoma in the nose, mouth, anus or genital tract; neither is caused by sun exposure, both are frequently diagnosed late, and their biology differs from common melanoma.

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against current NHS and UK specialist society guidance at the time of review.

  • 03

    Current for 2026

    Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.

Key facts

The essentials at a glance.

The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.

  • The commonest melanoma types in people with darker skin - and unrelated to UV exposure

  • A new pigmented streak in a nail, or a "bruise" on the sole that persists, needs biopsy

  • KIT mutations are more frequent, opening specific targeted treatment options

  • Immunotherapy works, though response rates are lower than in sun-related melanoma

Understanding the condition

What it is and what happens next.

What causes it, how it is diagnosed, and the treatment routes available in the UK.

What it is and how it feels

These melanomas grow where nobody is looking. On the sole, a dark patch is trodden on daily and assumed to be a bruise or wart; under a nail, a pigmented stripe is blamed on trauma; in the nasal cavity or genital mucosa, symptoms of bleeding or obstruction arrive only once the tumour is established. Hutchinson’s sign - pigment spreading onto the nail fold - and any changing palm or sole lesion warrant urgent dermatology review.

Diagnosis and treatment routes

Management follows melanoma principles - wide excision, sentinel node assessment where applicable, staging - but with molecular testing front and centre, since BRAF mutations are uncommon while KIT alterations are enriched and targetable. Immunotherapy remains the systemic backbone for advanced disease, and combination approaches are being refined in trials. In the UK these rarer subtypes are best channelled through specialist skin and head-and-neck MDTs. If you are waiting for results or want a second opinion on a proposed plan, a private consultation with a specialist who treats this condition regularly can usually be arranged quickly, and most will review your existing scans, biopsy reports and MDT correspondence.

Seeing a specialist

Who to see, and how quickly you can be seen.

The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.

A quiet reminder

This guide is for information, not medical advice.

Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.

Frequently asked

Common questions about Acral and mucosal melanoma.

Quick, plain-English answers to what people ask us most.

  • What is acral and mucosal melanoma?

    Acral melanoma develops on the palms, soles, or under the nails, while mucosal melanoma arises from mucous membranes such as those in the mouth, nose, or genital area; both are less common, distinct forms of melanoma skin cancer.

  • What causes acral and mucosal melanoma?

    Unlike most skin melanomas, these forms are not strongly linked to sun exposure; their exact cause is less well understood, though certain genetic mutations appear more frequently in these subtypes.

  • What are the symptoms of acral and mucosal melanoma?

    Symptoms include a new or changing dark patch or lesion on the palms, soles, under nails (sometimes a dark streak), or unusual pigmented or bleeding areas in the mouth, nose, or genital mucosa.

  • Is acral and mucosal melanoma dangerous?

    Yes, these forms are often diagnosed at a later stage because they occur in less visible areas, which can make them more challenging to treat; early detection significantly improves outcomes.

  • Is acral and mucosal melanoma genetic?

    There isn't a strong hereditary pattern for most cases, though specific tumour mutations differ from sun-related melanoma and can sometimes guide targeted treatment options.

  • Can acral and mucosal melanoma be cured?

    Early-stage disease can often be successfully treated with surgical removal, while more advanced disease requires additional treatments such as immunotherapy or targeted therapy, with outcomes depending significantly on stage at diagnosis.

  • How is acral and mucosal melanoma treated?

    Treatment usually starts with surgical excision, with additional options including immunotherapy, targeted therapy for specific mutations, or radiotherapy depending on location, stage, and spread.

  • How long does treatment take and what is recovery like?

    Surgical recovery ranges from a couple of weeks for smaller excisions to longer for more extensive procedures, while systemic treatments like immunotherapy are typically given over many months with regular monitoring.

  • Acral melanoma vs common sun-related melanoma — what's the difference?

    Common melanoma is strongly linked to UV/sun exposure and typically appears on sun-exposed skin, while acral melanoma occurs on the palms, soles, or nails regardless of sun exposure and often has different underlying genetic drivers.

  • When should I see a doctor about a suspicious mark, and how quickly can I be seen privately?

    See a doctor promptly for any new or changing pigmented area on the palms, soles, nails, or mucous membranes. NHS urgent skin cancer referral aims for two weeks, and private dermatology assessment is often available within a similar or shorter timeframe.