This systematic review and meta-analysis of 41 studies (≈9600 lesions) evaluated dermoscopic features distinguishing acral lentiginous melanoma (ALM) from benign acral nevi, finding that the parallel ridge pattern is the most sensitive and specific indicator of ALM, while parallel furrow and latticelike patterns are strongly associated with benign lesions; multicomponent structures also significantly support melanoma diagnosis, though about 20% of ALMs lack classic ridge features, highlighting the need for combined criteria to improve diagnostic accuracy and early detection.