Early-stage acral melanoma with a history of trauma associated with a poor prognosis:A multicenter data analysis of 468 cases

Abstract

Background：Previous studies have suggested that trauma may be a risk factor for the development and prognosis of acral melanoma (AM), but the available evidence is limited.This study aimed to explore the impact of trauma on AM recurrence and survival. Methods：This population-based retrospective cohort study included patients with acral melanoma with a clear history of trauma who were treated at five melanoma treatment centers in China from 2009 to 2023. Data were analyzed July 2023 to August 2023. Baseline characteristics of the two groups were analyzed using the chi-square test. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Factors associated with recurrence and survival were determined using univariate and multivariate Cox regression analysis. Results：A total of 468 AM patients were included in this study, with 101 in the trauma group and 367 in the non-trauma group. In the overall population, the median follow-up time was 57.4 months (95%CI, 53.84-61.03), with 248 (53.0%) males and 220 (47.0%) females. The peak age of onset was between 60-69 years old (31.2%) . In the trauma group, the plantars area was the most frequently affected site (54.5%), followed by the hallux toe (17.8%) and thumb (9.9%). The proportion of patients with ulcer (P=0.027) , mitosis rate ≥1 (P=0.036), and Clark level IV-V (P=0.009) was significantly higher in the trauma group compared to the non-trauma group. Multivariate analysis demonstrated that trauma was an independent risk factor for both DFS and OS in stage I-II. Furthermore, the cumulative survival rate revealed that the I-II trauma group had significantly lower than the non-trauma group. Conclusions：The results of this cohort study showed that trauma was found to be an independent risk factor for DFS in AM patients with stage I-II, affecting DFS and OS in AM.