Unique prognostic factors in acral lentiginous melanoma

Egger, Michael E.; McMasters, Kelly M.; Callender, Glenda G.; Quillo, Amy R.; Martin, Robert C.G.; Stromberg, Arnold J.; Scoggins, Charles R.

doi:10.1016/j.amjsurg.2012.05.013

Cited by 38 publications

(51 citation statements)

References 18 publications

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“…Our results are concordant with previous studies analyzing recurrence exclusively in ALM that reported recurrence rates of 25–30%, with most patients presenting with a loco-regional failure. 5, 7 Interestingly, in our series, the rate of distant metastases was similar in ALM and NAM, despite the fact that ALM patients experienced worse survival outcomes. To further elucidate the role of recurrence in survival in ALM, we compared melanoma-specific survival in patients who experienced a recurrence in both cohorts and demonstrated that survival was similar.…”

Section: Discussionsupporting

confidence: 49%

“…However, two studies analyzing recurrence exclusively in ALM reported recurrence rates of 25–30%, with a majority of patients presenting with a local or regional recurrence in the involved extremity. 5, 7 Possible risk factors for this finding include inadequate surgical margins, though margins less than 2 cm were not associated with an increased risk of loco-regional recurrence in one retrospective study. 5 …”

Section: Introductionmentioning

confidence: 95%

“…5, 7 Possible risk factors for this finding include inadequate surgical margins, though margins less than 2 cm were not associated with an increased risk of loco-regional recurrence in one retrospective study. 5 …”

Section: Introductionmentioning

confidence: 95%

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Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Gumaste¹,

Fleming²,

Silva³

et al. 2014

J Natl Compr Canc Netw

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Background Current surgical treatment of primary melanoma is uniform for all histo-subtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), carry a poor prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines in ALM compared to non-acral melanoma (NAM). Methods Study subjects were identified from a prospectively enrolled database of primary melanoma patients at Blinded for Review Purposes. ALM patients were matched to NAM patients (1:3) by gender and melanoma stage, including substage (ALM=61, NAM=183). All patients received standard of care treatment. Recurrence and survival outcomes in both cohorts were compared. Results ALM histologic subtype was an independent negative predictor of recurrence-free survival (HR = 2.45, p < 0.001) and melanoma-specific survival (HR= 2.64, p = 0.001) compared to NAM. Recurrence was significantly more common in ALM compared to NAM (49% versus 30%, p=0.007). In tumors less than 2mm in thickness, there was a significantly higher recurrence rate in ALM versus NAM (p=0.048). There was no significant difference in recurrence in tumors greater than 2mm (p= 0.12). Of note, the rate of loco-regional recurrence was nearly double in ALM compared to NAM (p=0.001). Conclusions Our data revealed a high rate of loco-regional failure in ALM compared to NAM when controlling for AJCC stage. Our results question whether ALM may require more aggressive surgical treatment than non- acral cutaneous melanomas of equal thickness, particularly in tumors less than 2mm thick. Revision of surgical margin recommendations based on larger multicenter cohorts may need to be considered.

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 95%

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Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Gumaste¹,

Fleming²,

Silva³

et al. 2014

J Natl Compr Canc Netw

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“…These data might also explain why older patients were less likely to have a survival benefit from lymphadenectomy compared to those <60 years of age [30]. Older patients have a greater preponderance of acral lentiginous melanomas as well as head and neck melanomas, including desmoplastic melanomas, that are associated with a lower incidence of nodal metastasis [31–35]. In addition, overlapping anatomic structures that make it difficult to localize head and neck sentinel lymph nodes on routine lymphoscintigraphy..…”

Section: Discussionmentioning

confidence: 99%

Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

et al. 2014

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Purpose We have previously reported that older patients with clinical Stage I and II primary cutaneous. melanoma had lower survival rates compared to younger patients We postulated that the incidence of nodal metastasis would therefore be higher among older melanoma patients. Materials and Methods The expanded AJCC Melanoma Staging Database contains a cohort of 7756 melanoma patients who presented without clinical evidence of regional lymph node or distant metastasis and who underwent a sentinel node biopsy procedure as a component of their staging workup Results Although older patients had primary melanoma features associated with more aggressive biology, we observed paradoxically a significant decrease in the incidence of sentinel node metastasis as patient age increased. Overall, the highest incidence of sentinel node metastasis was 25.8% in patients under 20 years of age, compared to 15.5% in patients 80 years and older (p< 0.001). In contrast, five year mortality rates for Clinical Stage II patients ranged from a low of 20% for those 20–40 years of age up to 38% for those over 70 years of age. Patient age was an independent predictor of sentinel node metastasis in a multifactorial analysis (p<0.001) Conclusions Patients with clinical Stage I and II melanoma under 20 years of age had a higher incidence of sentinel lymph node metastasis but, paradoxically, a more favorable survival outcome compared to all other age groups. In contrast, patients >70 years had the most aggressive primary melanoma features and a higher mortality rate compared to all other age groups, but a lower incidence of sentinel lymph node metastasis. Synopsis We analyzed the importance of patient age as a component of melanoma staging and in the design and interpretation of clinical trials for patients with localized disease or with regional node metastases.

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“…É uma lesão agressiva, de crescimento insidioso pela dificuldade de visualização (33,34). A radioterapia no melanoma tem sido considerada em indivíduos com melanoma em região de difícil ressecção como na face próximos aos olhos, sendo sua principal indicação para o tratamento da doença metastática, onde ocorrem respostas significativas (4,37).…”

Section: Melanomaunclassified

Efeitos da terapia com laser baixa potência em melanoma: ensaios in vitro

Santos¹

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Unique prognostic factors in acral lentiginous melanoma

Cited by 38 publications

References 18 publications

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Analysis of Recurrence Patterns in Acral Versus Nonacral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?

Age as a Predictor of Sentinel Node Metastasis among Patients with Localized Melanoma: An Inverse Correlation of Melanoma Mortality and Incidence of Sentinel Node Metastasis Among Young and Old Patients

Efeitos da terapia com laser baixa potência em melanoma: ensaios in vitro

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