Introduction
There is limited research examining the different aspects of genetic alterations between nail apparatus melanoma (NAM) and non-nail acral melanoma (NNAM)
Objective
To uncover previously unidentified novel mutations for the acral melanoma (AM) patients and genomic differences between the NAM and the NNAM
Design, Setting, and Participants
We performed whole-exome sequencing on DNA from 31 saliva samples and 31 tumor tissue  samples from Korean AM patients pathologically confirmed at Samsung Medical Center (Seoul, Korea) from September 2016 to March 2019. Mutational profiles were compared between NAMs and NNAMs.
Main Outcomes and Measures
The primary outcome measure was the genetic mutational profiles were obtained by whole-exome sequencing. Significantly deleterious mutations were investigated through algorithms for predicting protein functions with default parameters. We performed Fischer exact test for the comparison of genetic mutational profiles between NAM and AM.
Results
Prevalence of the detected well-known pathogenic mutations among the primary melanoma samples were BRAF V600E (16.13%), NRAS (9.68%), and KIT (3.23%). We also identified 53 genes that were repeatedly detected  in AMs including BRAF, NRAS, CACMA1E, CDC27, CYP4F2, DDX11, and PCMTD1. 19 genes were predicted to be deleterious in developing melanomas including CSMD3 and EHMT11 among repeatedly detected genes in AMs. Our results revealed several genes such as CES1, CSMD3, EHMT1, and MAGI1 were distinct mutations in the NAM.
Conclusions and Relevance 
We identified the mutational landscape, genetic alterations, and differences of genetic backgrounds between NAM and NNAM in the Korean population. Because genetic backgrounds are different for NAM and NNAM, it is necessary to approach each disease in a separate way.

Novel Mutations Identified by Whole Exome Sequencing in Acral Melanoma