The anatomic distribution of cutaneous melanoma: A detailed study of 5141 lesions

Abstract

Background/Objectives: There is evidence that cutaneous melanomas at different anatomic sites present with distinctive clinicopathologic features. We examined the anatomic distribution of cutaneous melanoma and its variation by patient characteristics, subtype and Breslow thickness, using high-resolution anatomic site data. Methods:A cross-sectional study was performed of all primary cutaneous melanoma cases managed at a tertiary referral centre, analysing prospectively collected clinical data across 50 anatomic subsites. Results:The study included 5141 in situ or invasive melanomas; most were invasive (76.2%), and the median Breslow thickness of invasive lesions was 1.0 mm. Superficial spreading (57.2%), lentigo maligna (20.8%) and nodular (12.2%) were the most common histopathological subtypes. Sun-exposed sites such as the female nose and cheek, the male ear, as well as the upper back in both sexes had the highest incidence of melanoma per unit area. When compared to the posterior forearm, the scalp, ear, preauricular, perioral, subungual and plantar sites had thicker invasive melanomas (each P < 0.05). The peri-auricular, ear and cheek had the highest incidence of nodular melanoma per unit area. There were subtype-, age-and sex-specific differences in melanoma anatomic distribution.Conclusion: Melanoma most commonly arises in sun-exposed facial areas, as well as the upper back. Increased thickness is found for melanoma in acral and many head and neck sites. Nodular melanoma is more likely to occur in head and neck sites including the peri-auricular area, ear and cheek. Clinicians should carefully assess these sites during skin examinations.

<p>Lentigo Maligna: Clinical Presentation and Appropriate Management</p>

“…Extrafacial LM/LMM is usually seen on the trunk in men or extremities in women. 25,26 submit your manuscript | www.dovepress.com…”

The impact of anatomical location and sun exposure on the dermoscopic recognition of atypical nevi and early melanomas: usefulness of an integrated clinical‐dermoscopic method (iDScore)

“…A significant trend of EM development was found in intermittently exposed body areas below 64 years of age, and in chronically exposed areas above 65 years 1 . However, EM simulating AN and AN mimicking EM are common until 70 years, and quickly recognizing while EM exploring the whole body surface can be challenging in daily clinical practice in patients with multiple atypical nevi 14–18 . Here in this data set of challenging aMSLs, we explored if and how the anatomical location can impact not only on the intuitive diagnosis but also on algorithm‐assisted diagnosis, when dermoscopists of different experience evaluate the dermoscopic and clinical image in a teledermatology setting 13 .…”

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

“…In particular for the scalp, a unique tissue lacking a proper donor site, preservation of patient’s hairlines, a high-tension-free wound closure, and a careful use of the electrocautery to avoid damage to the follicles are the basis for achieving an aesthetically acceptable result. Scalp localization is associated with Breslow thickness, independent of histopathological subtype, 2 and worse prognosis compared with other localizations. 3 Although the pathophysiology of this difference remains unclear, frequent amelanotic and nodular subtypes, especially in elderly bald male patients, lead to the consideration that chronic solar damage has an important role in their onset.…”