Plantar malignant melanoma – a challenge for early recognition

Abstract

The incidence of malignant melanoma has been continuously increasing over the last few decades. Non-plantar melanomas are nowadays usually diagnosed and treated surgically at an early stage. In contrast, melanoma in a plantar location is usually diagnosed at an advanced tumour stage, conferring a poor prognosis. To discover the reasons for this remarkable difference in recognition and prognosis, we analysed our cases of plantar malignant melanoma in a retrospective study. From 1990 to 1997, we treated 925 melanoma patients. Of these, 68 cases (7%) were classified as plantar melanoma. For non-plantar melanoma patients the mean age was 52.6 years, the mean Clark level was 2.8 and the mean tumour depth was 1.22 mm. In contrast, the mean age of patients with plantar melanoma was 63.3 years, the mean Clark level was 3.61 and the mean tumour depth was 2.55 mm. The mean time between the first observation of the plantar skin lesion and the first consultation with a physician (patients' delay) was 4.8 years and, on average, it took an additional 7 months before adequate surgical treatment was performed (physicians' delay). The prognosis of our patients was poor. In 98.5% (n = 67) further metastases were observed on follow-up. Since there is still no cure for advanced plantar malignant melanoma, the early detection and subsequent surgical treatment of plantar melanoma is decisive for the prognosis. Based on our results, the poor survival can be improved by a significant reduction in the time period between the first observation of a plantar skin lesion and surgical treatment. Therefore there is an urgent need for special preventive health care campaigns to reduce significantly both the patients' and the physicians' delay.

Palmoplantar Malignant Melanoma in the Brazzaville University Hospital

“…Franke and al. [3] noted a media age of 63,3±14,4 years at the time of diagnosis , which is similar to the result of our population sample. We can confirm, like other authors that PPMM is a pathology of the elderly [3][4][5].…”

“…In our setting, the occurrence of PPMM is a non-negligible reality (38, 4%) in the overall skin cancers registered against 5% for other authors [2,3]. Regarding the sex ratio, the data remains contradictory, we noted a female preponderance same as, but others African authors retrieve a male preponderance [4][5][6].…”

“…[3]. Late consultation is a frequent phenomenon in carcinology in our setting, which was demonstrated by Gombe and al.…”

“…[3] estimated that 94,4% of MM localized at the margin of the plantar pressure area. The literature review did not retrieve the plantar localization in African.…”

“…We can observe cutaneous in 90% of the cases but also in other sites such as eye mucus and meningeal [2]. In France, it represents 5% of all cutaneous cancers [3]. The palmoplantar sites were studied because of the incidence, a low survival rate due to less technical equipment in our setting, we will describe the diagnosis and treatment characteristics.…”