Clinicopathological Features and Prognostic Factors of Primary Acral Melanomas in Caucasians

Abstract

Background: Cutaneous melanomas located on the acral part of extremities (hand and foot melanoma; HFM) comprise a rare group within all melanomas in Caucasians. HFM is associated with a poor prognosis. We aimed to evaluate clinicopathological features, long-term outcomes, and prognostic factors in primary HFM in Caucasians. Methods: Medical records of all consecutive patients treated between 1997 and 2014 were revised. Patients were diagnosed with primary cutaneous melanoma at I-II clinical stage, and sentinel lymph node biopsy was conducted. The analysis was performed to define the clinicopathological factors influencing outcomes in the HFM and subungual cohort. Among 2537 consecutive patients diagnosed with primary cutaneous melanoma, 247 cases of HFM (9.7%) were found, with a median follow-up time of 7.8 years. Results: Median primary tumor Breslow thickness in subungual melanomas and HFMs was 4.0 mm and 3.3 mm, respectively, significantly higher than in the entire population (median 2.2 mm; p < 0.01). In the HFM group, 37.6% of tumors were ulcerated. Metastases to sentinel lymph node (SLN) were found in 28.3% of HFMs. The 10-year overall survival rate in the HFM group and subungual melanomas was 48.1% and 49.3%, respectively, compared to 63.0% in non-HFM melanomas. Conclusions: Our results confirm that patients with HFMs display worse overall survival compared to the entire melanoma population, with male gender and positive SLN biopsy status acting as independent negative prognostic factors.

Acral lentiginous melanoma histotype predicts outcome in clinical stage I-II melanoma patients: an International multicenter study

“…The ALM subtype was also suggested to have independent negative prognostic value in some studies, mainly from the Asian population, but limited data are available on the Western population. 18 , 19 , 20 , 21 Our study is in agreement and extends the results of a recent small study evaluating the impact of ALM histotype in patients with T1 stage. 22 …”

Volar location and degree of pigmentation are associated with poor survival and first metastasis pattern in acral melanoma

“…In this study, 26.8% of acral melanomas developed on the nails, and 73.2% developed on the volar surfaces of the hands and feet. Although acral melanoma has a worse prognosis than does non-acral melanoma (Borkowska et al, 2020), whether nail melanoma has a worse or better prognosis than volar surface acral melanoma remains unclear. No significant survival difference between patients with hand and foot melanoma and those with melanoma on the nails and on volar sites has been reported (Moon et al, 2018b;Paolino et al, 2016).…”

Mechanical Intermittent Compression Affects the Progression Rate of Malignant Melanoma Cells in a Cycle Period-Dependent Manner

“…Pathological diagnosis of minor melanoma subtype, which often occurs on the soles of feet, is difficult compared to other melanoma types [ 6 , 7 , 8 ]. In addition, the minor subtype responds poorly to current therapy strategies [ 14 , 15 , 16 ].…”

“…The incidence of malignant melanoma is increasing worldwide [ 2 , 3 , 4 ], but there are few effective pathological diagnostic techniques to find melanoma [ 5 ]. Although a classical “ABCDE” approach is generally considered useful for pathological evaluation of major melanoma subtype such as superficial spreading melanoma (SSM), the pathological evaluation of specific minor subtype is difficult, such as acral lentiginous melanoma (ALM) because the lesions are often heterogeneous and unique [ 6 , 7 , 8 ]. The difficulty in diagnosing delays the early detection of lesions, and the associated mortality rate is high because the stage of the disease is often advanced at the time of detection [ 9 , 10 ].…”