Plantar melanoma in black South Africans

Abstract

The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. Acral lentiginous melanoma (27 patients) was the most common histological type. The mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision with split skin grafting was used in 29 patients; four patients with neglected advanced plantar lesions had below-knee amputation and seven with metastatic disease did not undergo surgery. Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.

The Epidemiology of Cutaneous Melanoma in the White and Black African Population Groups in South Africa

“…The situation was markedly different in Black Africans as more than two-thirds of the CMs occurred on the lower limb and/or hip in both sexes. In confirmation, earlier surveys of Black Africans found CMs predominantly on the lower limb and sole (9), the sole and palm (21), and the foot (22). Such a distribution implies that the risk factors for CM development may differ between the White and Black African population groups in South Africa.…”

“…Age-specific rates increased with age among the study sample with the steepest trends in the age group of 55 years and above. Another study reported that the mean age at presentation of melanoma among Black Africans in Cape Town was 60.5 (22), while data from the NCR indicated that the mean age in both Black African and White South Africans was approximately 55 (13). No significant difference between Black Africans and Whites in the percentage of the cases presenting under the age of 40 was demonstrated, indicating that age as a risk factor did not differ with skin color (13).…”

“…One early study found that the 5-year survival rate in Black Africans with CM was 20% compared with 42% in the White population group (21). In Pretoria, 44 Black African patients out of 63 with CM died within a mean of 1 year of presentation, while 16 were alive after a follow-up of 5 years (22). A 15-year study in Pretoria included 175 Black African patients, most of whom presented with ALM at an advanced stage (52).…”

Dermatologia na pele negra

“…1,[10][11][12][13][14][15][16] Portanto, a radiação solar ultravioleta não é fator relevante para seu aparecimento, exceto no caso do carcinoma basocelular (CBC), que se desenvolve mais em áreas expostas ao sol; a ocorrência do carcinoma espinocelular (CEC) e do melanoma é maior nas áreas não fotoexpostas. [92][93][94][95][96][97][98][99][100][101][102][103][104][105][106] Os índices de morbidade e mortalidade são maiores em indivíduos negros. 107 O CEC é o mais freqüente, representando 30% dos cânceres em negros.…”

“…As causas possíveis para o prognóstico pior incluem a demora no diagnóstico, a presença freqüente de lesões primárias já mais espessas e os tumores acrais intrinsecamente mais agressivos. 105,106 No Brasil, a análise de dados das campanhas de prevenção ao câncer da pele, promovidas pela Sociedade Brasileira de Dermatologia de 1999 a 2005, evidenciou 17.980 casos (8,7%) de diferentes tipos de câncer da pele em meio aos 205.869 indivíduos examinados. A proporção de câncer nos indivíduos negros foi de 5% (1,6% nos pretos e 3,4% nos pardos) contra 3,2% nos amarelos e 12,7% nos brancos.…”