Acral lentiginous melanoma: a single‐centre retrospective review of four decades in East‐Central Europe

Abstract

Background Acral lentiginous melanoma (ALM) occurs on the palms, soles and subungual surface and has poor prognosis. It is uncommon in the Caucasian population and has remained unreported in East‐Central Europe. Objectives Our aim was to collect data from East‐Central Europe by analysing the demographic and clinicopathologic features of patients with ALM and comparing data with the reports in literature. Methods We conducted a single‐centre, retrospective review between 1976 and 2016 at one of the largest melanoma referral centres in Hungary. Results We identified 176 patients with ALM (3.83%) from 4593 patients with melanoma (mean age: 66.2 years). The tumours were mainly located on the lower extremities (88.63%). The mean Breslow tumour thickness was 3.861 mm, 37.50% of the tumours were thicker than 4.00 mm, and 71.6% exhibited microscopic ulceration. Nearly one‐third of the patients underwent sentinel lymph node (SLN) biopsy, and 60.3% of the biopsies were positive for metastasis. The positive SLN status was associated with significantly thick tumours and reduced survival. Patients with ALM had 5‐ and 10‐year overall survival rates of 60.5% and 41.6%, respectively. The mean delay in diagnosis was 18 months after the discovery of skin tumours. In multivariate analyses, age, tumour thickness and distant metastasis were independent risk factors for poor survival (P < 0.001). Conclusions Our study, which is the first single‐centre report in East‐Central Europe focusing on ALM, confirms that patient and tumour characteristics and prognostic factors are similar with previous literature data involving Caucasians; however, tumour thickness and survival suggest even worse prognosis.

Nomogram for Predicting Overall Survival in Acral Lentiginous Melanoma: A Population‐based Study

“…In this study, the median age at diagnosis in the training cohort and validation cohort was 65 and 66 years, respectively, and the interval between quartiles was 54–76 years old, which was similar to the results of Csányi’s study, indicating that ALM mainly affected the elderly. 24 It has been confirmed that elderly melanoma patients have a distinct natural history of disease in AJCC stages I, II, and III, with higher morbidity and mortality, 25 Therefore, the most likely reason for the influence of age on patient overall survival in this study was the inclusion of a large number of ALM patients with AJCC I, II, and III stage. In addition, there may be other reasons for this result, such as the decreased immune capacity of elderly patients, the increase of chronic inflammatory markers, and the elderly patients are more susceptible to more aggressive tumor invasion, which lead to the decreased survival rate.…”

Subungual Melanom Tanısında Gecikme: Bir Olgu Sunumu

“…It was demonstrated that the big toe was generally affected in SUM (4). Average tumor thickness has been estimated to be between 3.1 mm and 6 mm in the literature (3)(4)(5)(6), and the tumor thickness was approximately 2.0 mm in this case. Often, it first appears as longitudinal melanonychia, which may progressively extend or progress to thickening, splitting, or destruction of the nail plate with pain and inflammation (1, 2).…”

Caucasians with acral lentiginous melanoma have the same outcome as patients with stage- and limb-matched superficial spreading melanoma

“…Several previous investigations revealed that ALM represents a very aggressive CM subtype (Bello et al 2013;Csányi et al 2020;Duarte et al 2017). The question is, however, whether ALM really represents a biologically more aggressive CM subtype per se or whether the worse outcome observed in this melanoma subset is just due to delayed diagnosis and advanced stage at first presentation?…”

“…Indeed, many research groups have observed that overall survival rates of ALM patients are lower when compared to patients with SSM alone or all melanoma subtypes, except for ALM (Bello et al 2013 ; Csányi et al 2020 ; Duarte et al 2017 ; Huang et al 2020 ; Kuchelmeister et al 2000 ; Lv et al 2016 ; Phan et al 2006 ; Slingluff et al 1990 ). Using SSM as the reference category, El Sharouni et al ( 2020 ) observed adjusted hazard ratios of 1.26 (95% CI 1.06–1.50) for ALM.…”