Frequency of Trauma, Physical Stress, and Occupation in Acral Melanoma: Analysis of 313 Acral Melanoma Patients in Korea

Abstract

Background Traumatic events are thought to be a cause of acral melanoma. However, little is known about the role of mechanical trauma or physical stress in the development of acral melanoma. Objective In our study, we evaluated the frequency of trauma, physical stress, and occupation in patients with acral melanoma and aimed to identify any pathological correlates of these factors. Methods We conducted a retrospective study of 313 acral melanoma patients from Chonnam National University Hospital. We mapped melanoma-developed anatomical sites of acral areas and assessed patients' history of trauma, physical stress, and occupation. Results Among the 313 acral melanoma patients, many reported a traumatic event (84 of 313; 26.8%) or physical stress (91 of 313; 29.1%) before the melanoma developed. The most common anatomical sites in these patients were on the borders of the foot (136 of 313; 43.5%). Trauma was more commonly associated with the fingernails and toenails than other sites. The frequency of each type of physical stress depended on the site of the lesion. Farmer and fisherman were the most common occupations (130 of 313; 41.5%) of the acral melanoma patients. Conclusion Our results demonstrate that traumatic events, physical stress, and certain occupations are common in acral melanomas. Further studies are needed to establish whether these are risk factors for acral melanomas.

Photoprotection for Skin of Color

“…A study of the Surveillance, Epidemiology, and End Results (SEER) registry from 1986 to 2005 found that ALMs accounted for 36%, 18%, and 9% of melanomas diagnosed in Blacks, Asian/Pacific Islanders, and Hispanic Whites, respectively, compared with 1% of melanomas in non-Hispanic Whites [ 71 ]. Due to its similar incidence across racial/ethnic groups and tendency to develop in the relatively sun-protected palms and soles, ALM is not thought to be associated with UV radiation [ 16 , 71 , 74 , 79 ] and instead has been linked to mechanical stress and injury [ 81 , 82 ].…”

Acral Melanocytic Neoplasms: A Comprehensive Review of Acral Nevus and Acral Melanoma in Asian Perspective

“…Analysis in 313 Korean acral melanoma patients revealed that 26.8% reported traumatic events, and 29.1% experienced physical stress. The most common occupations were farmers and fishermen [ 49 ]. Physical stress, pressure, friction, maceration, irritation, and trauma may play roles in the pathogenesis of acral melanoma, and further studies are required to precisely determine the underlying molecular mechanism.…”

“…Deletions in PTEN and CDKN2A are seen in up to 25% of cases [ 51 ]. The earliest genetic alteration in acral melanoma is the amplification of CCND1 , which is detected in the very early stages of acral melanoma in situ [ 11 , 49 ]. In Taiwan, NRAS / KRAS mutations, cell cycle aberrations, increased copy numbers in antiapoptotic genes BIRC2 , BIRC3 , and BIRC5 , and the amplification of receptor tyrosine kinase genes were significantly enriched in acral melanoma [ 54 ].…”

Clinical features, molecular pathology, and immune microenvironmental characteristics of acral melanoma

“…Some studies have even suggested that trauma has a much greater impact on NAM than AM since NAM occurs more often in the thumb or big toe (75–90%), which are more susceptible to trauma [ 11 ]. One study has also found that NAM is more closely associated with trauma than non-nail acral melanoma (NNAM) ( p = 0.002) and that nails are most often affected by trauma, followed by toenails [ 7 ].…”

“…Non-nail acral melanomas are more common on the foot (82–88.6%) [ 4 , 5 , 15 ] and nail melanoma appears to be more common on the nails than on the toenails (58–61%) [ 7 , 12 , 15 , 20 ]. The prognosis for AM is worse than for CM.…”