Background: The use of ultrasound in dermatology is widespread. However, difficulties in performing ultrasound on irregular surfaces have diminished its role in the diagnosis of acral lesions. We introduce a convenient method to examine acral lesions using water-immersed ultrasound. Materials and Methods: Utilizing water as a sound conductor, water-immersed ultrasonography was used to examine acral lesions, including inflammatory lesions, cysts and tumors. Results: Water-immersed ultrasonography is an easily manipulated method with excellent real-time images. Conclusion: Water-immersed ultrasonography is an excellent method for the examination of acral lesions.