Acral Lentiginous Melanoma Is Associated with Certain Poor Prognostic Histopathological Factors but May Not be Correlated with Nodal Involvement, Recurrence, and a Worse Survival

Taş, Faruk; Ertürk, Kayhan

doi:10.1159/000488457

Cited by 16 publications

(26 citation statements)

References 8 publications

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“…Another study, 10 however, showed that the proportion of stage III/IV in the palm group was threefold higher than that in the nail bed group, which may be due to race variation. The overall distant metastases percentage in our study was comparable with previous literature 2 , 18 but the sole population had a higher proportion of distant metastases. No statistical difference was found for metastases of lung, liver, brain, bone, or non-regional lymph nodes across the 3 acral subgroups.…”

Section: Discussionsupporting

confidence: 91%

“…These are in keeping with Bradford et al's 3 and another 3 reports. 11,18,19 Meanwhile, previous studies 11,20,21 reported that more physical stress and trauma occurred in patients with sole primary sites, leading to higher recurrence and mortality risk. Inconsistent with our results, however, was the report by Lv et al; 7 they assessed 142 Chinese AM patients and found that sites of lesion had no significant impact on overall survival (OS).…”

Section: Discussionmentioning

confidence: 99%

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The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Wei

et al. 2020

Ann Surg Oncol

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Background. The clinicopathological and survival profiles across primary sites in acral melanoma (AM) are still controversial and unclear. Methods. This is a multi-center retrospective study. Clinicopathological data of AM patients diagnosed between 1 January 2000 and 31 December 2017 from 6 large tertiary hospitals in China were extracted. Chi square tests were used to compare basic characteristics between primary sites of sole, palm and nail bed. Melanomaspecific survival (MSS) differences based on primary sites were compared by log-rank tests and multivariate Cox regressions were used to identify prognostic factors for MSS. Results. In total, 1157 AM patients were included. The sole group had a more advanced initial stage, deeper Breslow thickness, higher recurrence rate and distant metastases risk (all P \ 0.05). The proportion of age \ 65 years and ulceration were statistically lower in nail bed and palm groups, respectively. A total of 294 patients underwent sentinel lymph node biopsy and rates of positive SLN status had no statistical difference across primary sites. Among 701 patients with genetic profiles, the mutational frequency of BRAF, C-KIT, and PDGFRA were similar except for NRAS (higher in sole group, P = 0.0102). The median MSS of sole, nail bed and palm patients were 65.0 months, 112.0 months, and not reached, respectively (log-rank P = 0.0053). In multivariate analyses, primary site, initial stage, ulceration and recurrence were the prognostic factors for MSS in overall population, but the statistical significance varied over primary sites. Conclusions. Substantial clinicopathological and survival heterogeneities exist across different primary sites in the AM population. Sole melanoma has worse prognosis compared with palm and nail bed subtypes. Melanoma is a malignancy with a steadily increasing incidence worldwide. Acral melanoma (AM) is a term referring to the melanoma affecting soles, palms, and nail beds. 1 It is documented as the least common subtype in Caucasians but constitutes up to 50-75% in populations of color. 2-5

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Wei

et al. 2020

Ann Surg Oncol

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“…The majority of ALM are diagnosed in the lower extremities, where most are located on the plantar sole and relatively few occur in the toenail apparatus. 5,13,[15][16][17] Conversely, most upper limb ALMs are associated with the fingernail apparatus. 13,17 There is conflicting evidence whether clinicopathologic variables differ between upper and lower limb ALM 18 and between nail and non-nail ALM.…”

Section: Introductionmentioning

confidence: 99%

“…The acral locations diagnosed with ALM have an interesting distribution. The majority of ALM are diagnosed in the lower extremities, where most are located on the plantar sole and relatively few occur in the toenail apparatus 5,13,15‐17 . Conversely, most upper limb ALMs are associated with the fingernail apparatus 13,17 .…”

Section: Introductionmentioning

confidence: 99%

Acral lentiginous melanoma: Clinicopathologic and survival differences according to tumour location

et al. 2020

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Background/Objectives: Acral lentiginous melanoma (ALM) is a melanoma subtype associated with atypical locations on the hands and feet and advanced disease at diagnosis. There is a limited understanding of whether the survival is similar for nail, non-nail, lower limb and upper limb ALM patients. We therefore explored clinicopathologic characteristics and melanoma-specific survival of ALM patients according to tumour location. Methods: A prospectively collected cohort study was performed of all primary invasive cutaneous acral lentiginous melanomas with known thickness and tumour location reviewed at a tertiary referral centre over 21 years. Results: A total of 101 ALM patients were reviewed from 1994 until 2016. The majority of cases (82/101) occurred on the feet. Hand ALMs were thicker and more likely to be ulcerated than feet ALMs (P = 0.05 and 0.02, respectively); however, survival was not statistically different between these two groups (univariate HR 0.48 P = 0.11, 95% CI, 0.20-1.17; multivariate HR 0.67 P = 0.40, 95% CI, 0.27-1.69, respectively). Non-nail ALM patients had longer survival when compared to nail ALM on univariate analysis (HR 0.40, 95% CI, 0.17 to 0.90) which was accounted for by Breslow thickness and ulceration (multivariate HR 0.56, 95% CI, 0.24 to 1.34). Conclusions: The reduced melanoma-specific survival in nail ALM patients was likely due to their greater thickness and ulceration. Although hand ALMs are thicker and more frequently ulcerated, this is likely due to the higher proportion of nail ALMs present in this location.

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“…In the present study, the low ORR after ICB therapy could be attributed to the modest response to the acral/mucosal subtype. In particular, acral melanoma is a skin malignancy with a low mutational burden that negatively influences the response to ICB therapy and results in poor prognosis relative to that of the other subtypes [ 4 - 6 , 16 , 17 ]. Furthermore, the incidence of the different subtypes of melanoma differs according to ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Immune Checkpoint Blocker Therapy for Malignant Melanoma in Korean Patients: Potential Clinical Implications for a Combination Strategy Involving Radiotherapy

et al. 2020

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PurposeWe investigated the clinical efficacy of immune checkpoint blocker (ICB) therapy for metastatic or advanced melanoma in Korean patients. As well, we assessed whether the effects of ICBs can be enhanced by combination therapy with palliative radiotherapy (RT).Materials and MethodsWe retrospectively reviewed the records of 127 patients with metastatic melanoma who received ICB with or without palliative RT between 2014 and 2018. The melanoma subtypes were classified as follows: chronic sun-damaged (CSD), acral, mucosal, and uveal. The primary endpoint was the objective response rate (ORR).ResultsThe overall ORR was 15%, with 11 complete and eight partial responses. ORRs for CSD, acral/mucosal, and uveal melanomas were 50%, 16.5%, and 0%, respectively (p=0.009). In addition to the subtype, stage at treatment, total tumor burden at treatment, and ICB type were significantly associated with ORR (all p < 0.05). Palliative RT was administered in 44% of patients during the treatment, and it did not affect ORR. Clinical responders to ICB therapy exhibited significantly higher 1-year progression-free and overall survival rates than nonresponders.ConclusionORR for ICB monotherapy in Korean patients with melanoma is relatively modest compared with that in Western patients because the non-CSD subtypes are predominant in the Korean population. Our findings regarding combination therapy with ICB provided a rationale for the initiation of our phase II study (NCT04017897).

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Acral Lentiginous Melanoma Is Associated with Certain Poor Prognostic Histopathological Factors but May Not be Correlated with Nodal Involvement, Recurrence, and a Worse Survival

Cited by 16 publications

References 8 publications

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma

Acral lentiginous melanoma: Clinicopathologic and survival differences according to tumour location

Clinical Outcomes of Immune Checkpoint Blocker Therapy for Malignant Melanoma in Korean Patients: Potential Clinical Implications for a Combination Strategy Involving Radiotherapy

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