Case Report: An 88-year-old male presented with biopsy-confirmed acral lentiginous melanoma of the right 3rd and 4th toes (Breslow 0.5mm, non-ulcerated). Definitive management required formal amputation at the metatarsophalangeal joint level and split-skin grafting. To mitigate risks of symptomatic neuroma and phantom limb pain, dermal sensory-Regenerative Peripheral Nerve Interfaces (dsRPNI) were performed. Following excision, terminal ends of the plantar nerve branches were identified. Small autologous dermal grafts were harvested, transposed to the nerve ends, and secured with 6-0 Prolene. At 3-month follow-up, the patient reported nil neuropathic pain, showed no clinical evidence of neuroma, and successfully transitioned to custom orthotics without sensitivity. Purpose: Acral melanoma often necessitates digital or ray amputations, leaving patients prone to debilitating post-amputation pain that complicates rehabilitation. This case aims to demonstrate the feasibility and early success of applying RPNI techniques – traditionally reserved for proximal limb loss – to distal foot amputations to improve functional and quality-of-life outcomes. Discussion: RPNIs provide a physiological target for transected nerves, facilitating organized reinnervation and preventing the terminal axonal bulbs that form painful neuromas. While standard RPNIs utilize muscle, this dsRPNI variation utilizes dermal grafts, which are easily accessible in foot reconstruction. This technique does not compromise oncological margins and can be performed concurrently with wide local excision or sentinel lymph node biopsy. Prophylactic nerve management reduces long-term reliance on neuropathic analgesics and improves tolerance for orthotic loading. Conclusion: Applying dsRPNI in foot acral melanoma is a novel, effective strategy to prevent neuropathic sequelae. As surgical oncology shifts toward functional restoration, regenerative peripheral nerve techniques should be considered a standard adjunct in digital amputations.