Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous melanoma, primarily affecting individuals with darker skin. This case series presents four unique instances of nodular ALM, highlighting the association of trauma with disease progression, a factor underreported in existing literature.

We report four patients aged 30 to 72 years, each presenting with nodular masses that evolved from stable pigmented lesions. Notably, all cases followed a history of trauma, resulting in significant clinical features such as rapid lesion growth and associated lymphadenopathy. Histopathological evaluations confirmed atypical melanocyte nests and pagetoid spread in all cases, reinforcing the diagnosis of nodular melanoma.

This series underscores the importance of recognizing the nodular presentations of ALM, particularly in patients with a history of trauma, which may lead to misdiagnosis and delayed treatment. The findings reveal a younger demographic, with an average age of 55.3 years, challenging prior assumptions about ALM’s typical patient profile. The critical takeaway is the necessity for heightened awareness and thorough diagnostic evaluation in similar cases to ensure timely intervention and improved patient outcomes. Our observations advocate for further research to elucidate the relationship between trauma and ALM progression.