Dermoscopic Features for Differentiating Acral Melanoma From Acral Nevi: A Systematic Review and Meta‐Analysis

Background Dermoscopy assists clinicians in the evaluation of acral melanocytic lesions and improves the detection of acral melanoma. Although individual dermoscopic features have been described in previous studies, the overall diagnostic performance of these features has not been synthesized across studies. Objectives To assess the diagnostic utility and accuracy of dermoscopic features commonly associated with acral melanoma. Methods Ovid MEDLINE, Embase, the Cochrane Library, and Web of Science were searched from inception to December 31, 2025. Three reviewers evaluated the studies, including the studies that had at least 3 acral melanoma cases with a comparison group of acral nevi, and excluded review articles, small case series and reports without a control group. Of the 894 initially identified studies, eleven met the selection criteria. Data extraction followed PRISMA guidelines and risk of bias assessment was conducted using QUADAS‐2. Data were pooled using the bivariate generalized linear mixed model. Diagnostic utility was assessed by calculating the positive likelihood ratio (PLR), and diagnostic accuracy was evaluated using the area under the curve value (AUC). Results This meta‐analysis of eleven studies found that the dermoscopic features that can strongly support a diagnosis of acral melanoma are the diffuse irregular pattern (PLR 79.034, AUC 0.962), peripheral or irregular dots and globules (PLR 73.095, AUC 0.769), abrupt edge pattern (PLR 52.033, AUC 0.980), and parallel ridge pattern (PLR 36.606, AUC 0.971). In contrast, the parallel furrow (PLR 7.075, AUC 0.859) and lattice‐like (PLR 4.669, AUC 0.688) patterns were more frequently observed in acral nevi than in acral melanoma. Limitations This study was limited by the relatively small number of eligible studies, insufficient data for subgroup analyses by melanoma stage and ethnicity, and inconsistent terminology and reporting of dermoscopic patterns. Conclusions Recognition of key dermoscopic features enables accurate, evidence‐based differentiation of acral melanoma from acral nevi, thereby supporting early diagnosis and more informed clinical decision‐making. Systematic Review Registration PROSPERO CRD420261293469.