Acral lentiginous melanoma: a skin cancer with unfavourable prognostic features. A study of the German central malignant melanoma registry (CMMR) in 2050 patients

Abstract

SummaryBackground Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous melanoma (CM). Although ALM has a poorer prognosis than other CM subtypes, the prognostic factors associated with ALM have only been verified in small-sized cohorts because of the low incidence of ALM worldwide. Objectives To investigate the clinical characteristics of ALM and to evaluate their prognostic values based on a large dataset from the Central Malignant Melanoma Registry (CMMR) of the German Dermatologic Society. Methods The Kaplan-Meier method was used to estimate the potential influence of clinical and histological parameters on ALM disease-specific survival (DSS) curves, which were compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors for DSS. Results In total, 2050 patients with ALM were identified from 58 949 patients with CM recorded by the CMMR with follow-up data. In multivariate analyses, age (P = 0Á006), ulceration (P = 0Á013), tumour thickness (P < 0Á001) and tumour spread (P < 0Á001) turned out to be significant prognostic factors for DSS in ALM whereas sex, nevus association and level of invasion were not independent factors. Conclusions ALM has the same prognostic factors as other subtypes of melanoma. Unfavourable prognosis probably derives from the delay in diagnosis in comparison with other melanoma subtypes.

Acral lentiginous melanoma: differences in survival compared with other subtypes

“…Previous matched and adjusted analyses have demonstrated poorer survival of patients with ALM compared with those who do not have ALM; however, this was not corroborated in other large prognostic studies . Nevertheless, in contrast to our study, the studies demonstrating differences lacked adjustment for ulceration and mitotic rate, which differed significantly between NM, ALM and SSM in our patients and another report . This significant change in chance of survival between unadjusted and adjusted associations for subtypes demonstrates that univariable models can be misleading as they do not take into account clinicopathological differences between subtypes.…”

“…D ear E ditor , Acral lentiginous melanoma (ALM) is typically diagnosed at an advanced stage, which may be due its unique presentation . Studies have evaluated whether the ALM subtype is an independent prognostic factor, and shown conflicting results .…”

“…Studies have evaluated whether the ALM subtype is an independent prognostic factor, and shown conflicting results . Previous reports have been limited by small numbers and lacked adjustment for confounders . Therefore, the aim of this study was to compare the melanoma‐specific survival (MSS) of patients with ALM with that of patients with other melanoma subtypes.…”

Efficacy of combined radiotherapy and anti‐programmed death 1 therapy in acral and mucosal melanoma

“…Acral melanoma and mucosal melanoma have poorer prognoses than cutaneous melanoma . In particular, mucosal melanoma is an aggressive malignancy and is often diagnosed at advanced stages.…”

Prognostic features for acral lentiginous melanoma

“…In this issue of the BJD , Teramoto et al . make an important contribution to our knowledge of the prognostic factors associated with acral lentiginous melanoma (ALM) . They used data from 2050 patients recorded in the Central Malignant Melanoma Registry of the German Society of Dermatology over a 32‐year period, representing the largest cohort of patients with ALM reported to date.…”