Acral with melanoma: A review of 185 patients identification of prognostic variables

Abstract

One hundred eight-five patients with acral melanoma treated since 1972 were reviewed. These included 53 subungual lesions, 123 plantar lesions, and 9 palmar lesions. Eighty percent presented with stage I disease. Mean age was 57 years. Males outnumbered females 1.1:1. Seventeen percent (17%) were blacks. Actuarial 10-year survival was 58% for stage I patients and 35% for stage II patients. Univariate Cox regression analyses identified 5 prognostic variables affecting survival: stage at diagnosis (P less than 0.001), race (P less than 0.001), ulceration (P = 0.012), Clark's level (P = 0.014), and thickness of the primary lesion (P = 0.013). Factors unrelated to survival included sex of the patient, site (volar vs. subungual), histology, and treatment with amputation. Multivariate analysis for patients with stage I lesions identified race (P = 0.001) and ulceration (P = 0.018) as significant variables, with thickness approaching significance (P = 0.094). In an additional series of 71 patients with melanomas arising from extremity sites near the junction of glabrous and non-glabrous skin, survival was significantly poorer for those arising from glabrous skin (P = 0.024), and reflects a higher incidence of metastatic disease at diagnosis. Specific active immunotherapy was the principal adjuvant used for these patients, and survival was comparable to that reported with regional perfusion therapy. Acral melanoma a) has a strong racial predilection, b) carries a grave prognosis, and c) arises from glabrous skin. It is a clinical entity distinct from other extremity melanomas. Surgical management with either wide excision or amputation is appropriate for the primary lesion.

A Clinicopathologic Analysis of 177 Acral Melanomas in Koreans

“…There was no significant sex predominance, and the mean age was 55.3 years, which is similar to the results (male to female ratio, 1:1.22; mean age, 55.9 years) in another study on acral melanomas in Korean patients. 3 In previous studies, 4,12,13,[15][16][17][18] the mean age was 55 to 63 years, and no significant sex pre- Clinicopathologic characteristics of acral melanoma in Koreans indicated a high ulcerative rate (42.3%) and high proportion of Breslow thickness of 4 mm or more (32.9%; T stage 4), which might explain the lower 5-year survival rate (49.3%). The overall survival rate among all racial groups did not show statistically significant variation when controlling for Breslow thickness and tumor stage at diagnosis.…”

The history and future of melanoma staging

“…It must also be borne in mind that the information in the AJCC database used to determine new TNM categories was largely based on melanomas with superficial spreading and nodular growth patterns. However, as the authors of the article outlining the new staging system acknowledged [22], other growth patterns may have a different etiology and prognosis [34,35].…”

Prognostic Factors in Cutaneous Melanoma

“…Large multivariate analyses have nonetheless confi rmed the independent effect of site on survival [ 2 ]. Extremity melanomas have a better than expected prognosis compared with other sites [ 2 ], whereas scalp and the glabrous skin of the acra are considered prognostically adverse sites [ 106 ]. Additional multivariate analyses have shown an unfavorable prognosis associated with location on the scalp, neck, and trunk [ 14 ] or with sites on the thorax, upper arm, neck, and scalp ("TANS") [ 131 ].…”

“…The relatively poor prognosis of acral lentiginous melanomas has been explained by the adverse effect of location at acral, glabrous (non-hair-bearing) sites [ 106 ]. Moreover, imprecise interobserver concordance has been observed in the classifi cation of melanoma subtypes, with a kappa value reported to be 0.52 [ 40 ].…”