Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: A study of 522 consecutive cases

Abstract

BackgroundMalignant melanoma is a rare disease in Asia, and knowledge on its characteristics and clinical outcome in Asian patients is limited. The purpose of this observational study was to determine the clinical presentation and outcome of patients with melanoma in China.MethodsA database was prospectively established for the purpose of this analysis. The elements of the database included basic demographic data of patients and prognosticators previously reported in literature, as well as follow-up data including clinical outcome after treatment. Medical record of all patients with pathologically diagnosed malignant melanoma consulted in our center since 2006 were retrieved and reviewed. No patient was excluded in this study. Statistical analyses including survival and multivariate analyses of factors associated with survival were respectively performed by Kaplan-Meier method and Cox proportional hazard model.ResultsA total of 522 consecutive and nonselected cases were evaluated. There were 218 cases (41.8%) of acral lentiginous melanoma (ALM), 118 (22.6%) of mucosal melanoma (MCM), 103 (19.7%) of nodular melanoma (NM), 33 (6.3%) of superficial spreading melanoma (SSM), and others were Lentigo maligna melanoma or unclassifiable disease. The proportion of patients with clinical stage I, II, III, and IV diseases were 6.1%, 55.9%, 25.1%, and 12.8%, respectively. Among the 357 cases of cutaneous melanoma, 234 patients (65.5%) had ulceration.The 5-year overall survival rate of all 522 patients was 41.6%, and the median survival time was 3.92 years (95% CI, 3.282 to 4.558). Five-year survival rates of patients with stage I, II, III, and IV diseases were 94.1%, 44.0%, 38.4% and 4.6% respectively (P < 0.001). Multivariate analysis revealed that clinical stage and the ulceration were two significant prognosticators for OS. In addition, extent of surgery and use of adjuvant therapy were significant prognosticators for DFS in patients with non-metastatic disease after definitive treatment. Pathological subtype was not a significant prognostic factor to predict wither OS or DFS.ConclusionsPrognoses of patients with malignant melanoma diagnosed in China were suboptimal, and most patients were diagnosed with locally advanced disease (i.e., stage II or above). ALM and MCM are the two most commonly diagnosed pathological subtypes. Clinical staging and presence of ulceration was significantly associated with clinical outcome in terms of OS, while treatment strategy including extent of surgery and use of adjuvant therapy were significant predictors of DFS.

Clinical report. Acral melanoma in Cambodia: challenges associated with a rare and aggressive disease encountered in a developing country setting

“…The mean age in other studies is slightly lower than our 65.3 years (from 55.9 [13] to 61 years [14]). The proportion of ALM of all melanoma in other studies ranges from 41.8% [15] to 85.9% [9], therefore the reported 8/10 "likely ALM" reported here is within the reported range of the region. The palms and plantar foot are also the most common sites of ALM reported in Asia, although typical percentages range from 44% [16] to 69% [13], rather than 100% of ALM diagnosed at CSC.…”

“…Nevertheless, assuming a best-case scenario for all other patients, we have at best an 8/ 10 patient 6-month survival in this series, compared with an overall 80.3% 5-year survival rate of ALM in a study from the USA. We note, however, 5-year survival rates from studies in Asian countries are typically 41%−49% [9,14,15]. This is likely to be a direct result of the late presentation and late stage of the patients in this series.…”

Malignant Melanoma Presenting as Bilateral Pleural Effusion

“…A study from China which reviewed 522 patients with malignant melanoma found that most patients presented with locally advanced disease and had suboptimal prognosis. They also concluded that clinical staging and ulceration were significant predictors of overall survival while extent of surgery and use of adjuvant therapy were significant predictors of disease free survival [4].…”

Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition)

“…In a study enrolling 522 Chinese melanoma patients, tumors arising from extremities accounted for 41.8%, followed by those occurred in mucous membrane (e.g., rectum, anus, vulva, eyes, and nasopharyngeal area; accounting for 22.6%); 10% of cases had unknown primary sites. For Caucasians, melanoma arising from skin accounted for about 90%, which is commonly seen at the skin of back, chest, abdomen, and lower limbs; melanoma arising from mucous membrane and acral areas accounted for only 1−5% (9).…”