Risk factors of recurrence and distant metastasis in primary cutaneous melanoma in Taiwan

Abstract

Risk factors of recurrence and distant metastasis of acral lentiginous melanoma (ALM) are of great interest for the high percentage of ALM in cutaneous melanoma in Asian populations. This single-center retrospective cohort including 177 patients with localized melanoma diagnosed from 2004 to 2020 aims to identify adverse predictors in cutaneous melanoma in Taiwan, with a focus on ALM. The relationship between clinicopathological features and outcomes, including incidences of recurrence and distant metastasis in 5 years from diagnosis, was analyzed. This study included 124 patients (70.1%) with ALM and 53 (29.9%) with non-ALM melanoma. Regarding clinicopathological characteristics, ALM patients were diagnosed at an older age and received sentinel lymph node biopsies (SLNBs) more often, while adjacent melanocytic nevi were more prevalent in non-ALM patients. With respect to prognostic implications of clinicopathological features, in ALM, implementation of SLNB was associated with a lower 5-year distant metastasis rate. Thickness of melanoma lesions over 4 mm, ulceration, and neurotropism, were related to both higher 5-year recurrence and distant metastasis rates. With regard to non-ALM patients, diagnoses made at or over 65 years old was linked to a higher 5-year recurrence rate, whereas ulceration was associated with both higher 5-year recurrence and distant metastasis rates. In conclusion, several clinicopathological characteristics have been identified to be associated with poor prognosis of cutaneous melanoma, especially ALM.

Major Histotypes in Skin Melanoma: Nodular and Acral Lentiginous Melanomas Are Poor Prognostic Factors for Relapse and Survival

“…The poor prognosis of ALM has been indicated in several studies. 3,[10][11][12][13] In the American SEER registry study, the 5-year melanoma-specific survival rates of ALMs were lower than cutaneous melanoma overall (80.6% vs. 93.0%, P , 0.001, respectively). 10 Survival differences were significant between non-Hispanic whites and blacks in stage I (P = 0.004) and stage III (P = 0.005) patients.…”

“…In another retrospective cohort study from Taiwan (n = 124), several clinicopathological characteristics have been identified to be associated with poor prognosis of cutaneous melanoma. 12 ALM patients were diagnosed at older ages and received SLNBs more often. In ALM, implementation of SLNB was associated with a lower 5-year distant metastasis rate.…”

“…1,2 The prognostic value of histologic subtype in cutaneous melanoma patients is controversial, with divergent results in many studies. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The prognostic influence of histologic subtype is usually weaker than that of other major predictors, such as tumor depth, ulceration, mitotic rate, and age. Therefore, our aim was to investigate the role of melanoma histology subtypes on survival using data from a tertiary cancer center in Turkey.…”

Melanoma of the Upper Limb and Shoulder: A Surveillance, Epidemiology, and End Results Analysis of Epidemiology and Survival 2000–2019

“…AJCC stage I and II was found to be associated with loco-regional relapse, whereas stage III provoked distant relapse [ 40 ]. Histopathological subtypes such as nodular melanoma or acral lentiginous melanoma were associated with more aggressive histopathological characteristics such as deeper Breslow, presence of ulceration, or lymphovascular invasion, resulting in a higher relapse rate [ 41 , 42 ].…”

The Importance of Immunohistochemistry in the Evaluation of Tumor Depth of Primary Cutaneous Melanoma

“…After a while, the tumor becomes invasive, extends to the dermis and more profound structures, and then to blood and lymph vessels, therefore aquiring metastatic potential [ 8 ]. The risk of metastasis is correlated with the tumoral invasion evaluated as the Breslow thickness, but also with other factors such as ulceration and mitotic rate [ 9 , 10 ]. Theoretically, melanoma in situ does not metastasize, but there have been cases reported of metastatic disease, probabably due to unidentified small clusters of tumoral cells in the dermis or as a consequence of regression [ 11 ].…”