Treatment Outcomes of Advanced Stage Malignant Melanoma in Hand and Foot after Amputation in Korean Patients

Abstract

BackgroundA retrospective study was conducted to review the overall survival and treatment outcomes of high grade melanoma in the extremity to explore the clinical features of malignant melanoma of the hand and foot, and the therapeutic efficacies and survival rate after amputation.MethodsThe clinical data of 30 patients with malignant melanoma of the hand and foot (confirmed by pathological examination), who were admitted and treated in our hospital between 2001 and 2010, were analyzed retrospectively. We analyzed variables affecting overall and disease-free survival.ResultsThirty patients (18 men and 12 women) treated with an amputation procedure for malignant melanoma in the hand or foot constituted the study cohort. The average age of the patients at the time of diagnosis was 58.7 years. Univariate analysis for overall melanoma survival revealed that diagnosis at over 70 years of age, postoperative lymph node metastasis, and location of the tumor were significant prognostic factors. And on the Kaplan-Meier survival curve, old age, American Joint Committee on Cancer stage and postoperative lymph node metastasis showed statistically significant differences in the 5-year survival rate. Also, amputation with aggressive lymph node dissection showed improved long term survival in advanced stage melanoma.ConclusionsIn Korean melanoma patients, for the treatment of high grade melanomas in the extremities after amputation, early diagnosis and postoperative follow-up for evaluation of lymph node metastasis are critical factors for long-term survival. And by performing lymph node dissection during amputation, we may improve the survival rate in advanced stage melanoma patients.

A Rare Disease Presentation of Malignant Fungating Acral Melanoma of the Hand

“…Yang et al 4 reported survival rates of 86.4%, 42.1%, and 31.2% at 1, 3, and 5 years of follow-up, respectively, in patients who received chemotherapy and immunotherapy following digit amputation. Cho et al 6 reported a similar 5-year survival rate in patients who underwent amputation of late-stage malignant melanoma of the hand and foot. These authors reported a poorer prognosis with advanced age, lymph node metastasis, and tumor location on the lower extremities.…”

“…Early diagnosis is important and demonstrates improved clinical outcomes. 4 , 6 Excisional biopsy with 2-mm clear lateral margins and deep margins that extend to the subcutis layer are recommended for lesions with suspicion of melanoma. The current excision guidelines range from a 5-mm clear margin for melanoma in situ to a minimum of 2-cm clear margins for melanoma greater than 4 mm in thickness.…”

“… 4 Chemotherapy and biologic therapy have historically shown low efficacy in the treatment of malignant melanoma, and the majority of patients undergo amputation for definitive treatment of the affected area. 4 , 6 Because of the rarity of malignant melanoma of the hand, we present a case of a 48-year-old man with a nodular melanoma affecting the fifth distal phalanx. We describe the presentation and treatment of this patient, who ultimately underwent amputation of the fifth ray to the midshaft of the metacarpal.…”

Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function

“…In this region, surgeons have previously advocated digit amputation for lesions in which appropriate surgical margin cannot be achieved. 5,6 Recent studies have Reconstruction after Mohs Surgery for Digit Melanoma Wink et al…”