Impact of clinical and histopathological characteristics on the disease‐free survival of stage I‐II acral melanoma patients

Abstract

BackgroundAcral melanoma is rare and associated with a worse prognosis compared to cutaneous melanoma in other locations. Despite this, few studies have focused on the prognosis of acral melanoma, particularly in patients with initial clinical stage. The aim of this study was to assess the impact of clinical and histopathological characteristics on the disease‐free survival (DFS) of stage I‐II patients.MethodsWe analyzed 154 stage I‐II acral melanoma cases, all of whom underwent a review of the histopathological and clinical parameters. Patients were divided into groups based on the presence or absence of disease recurrence within 5 years. We used Cox proportional regression to analyze independent risk factors and computed DFS curves using the Kaplan–Meier method.ResultsWithin 5 years, 27.9% of patients experienced disease recurrence, with 90.4% occurring during the first 3 years. Univariate and multivariate analyses did not identify any clinical parameters with a significant influence on DFS. The DFS rate at 5 years was 72.7%. The median duration of disease recurrence after the initial diagnosis was 21 months. However, Breslow thickness, presence of ulceration, >3 mitosis/mm2, presence of tumor‐infiltrating lymphocytes (TIL), and perineural invasion were significantly associated with a decrease in time to first recurrence.ConclusionsDespite the favorable prognosis of stage I‐II acral melanoma compared with advance stage, clinical and histopathological characteristics can impact prognosis. In addition to Breslow thickness and ulceration, attention should be paid to mitotic rate, presence of TIL, and perineural invasion to optimize follow‐up of acral melanoma patients diagnosed in the initial clinical stage.

The Prognostic Value of Proliferative Activity in Cutaneous Melanoma: A Pilot Study Evaluating the Mitotic Rate and Ki67 Index to Predict Patient Outcomes

“…Perineural invasion is generally considered unusual and of little prognostic value in cutaneous melanomas, with the notable exception of desmoplastic melanomas where it has been associated with local recurrence [ 28 ]. Nevertheless, perineural invasion has also been linked to local recurrence, sentinel lymph node positivity, in-transit metastases, and reduced PFS and OS in other types of cutaneous melanomas [ 29 , 30 , 31 , 32 , 33 ]. Moreover, a few recent studies have proven that perineural invasion is an independent prognostic factor for cutaneous melanomas in general [ 34 , 35 ].…”