Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3618–3625 | Cite as

Prognosis of Acral Melanoma: A Series of 281 Patients

  • Danielle M. Bello
  • Joanne F. Chou
  • Katherine S. Panageas
  • Mary S. Brady
  • Daniel G. Coit
  • Richard D. Carvajal
  • Charlotte E. Ariyan
Melanomas

Abstract

Background

Acral melanoma (AM) is an unusual malignancy with poor survival. This study defines a cohort of patients, treated at a single institution, and the factors associated with survival and comparison with nonacral cutaneous melanoma (NACM).

Methods

All patients with AM presenting from 1995 to 2010 were identified from a prospectively maintained database. Analysis of clinicopathologic features of AM associated with disease-specific survival (DSS) was performed. A stratified, stage-matched survival analysis compared the outcome of 281 acral to 843 extremity NACM patients.

Results

A total of 281 AM patients (170 volar, 111 subungual) were identified. Pathologic stage (p < 0.001), ulceration (p < 0.001), Breslow thickness (p < 0.001), and a positive sentinel lymph node (p < 0.001) were found to be poor prognostic indicators associated with DSS. In stage-matched analysis, AM had a worse DSS compared with NACM (hazard ratio 1.8; 95 % CI 1.2–2.7; p < 0.01).

Conclusions

This study represents the largest, single-institution series describing the characteristics and outcomes of AM. AM tumors exhibit aggressive histopathologic features associated with a poorer survival outcome. AM patients have an inferior survival than extremity NACM when matched for stage, perhaps reflecting inherent alterations in tumor biology. This warrants further investigation into the differences between acral and cutaneous melanoma.

Keywords

Melanoma Sentinel Lymph Node Sentinel Lymph Node Biopsy Cutaneous Melanoma Positive Sentinel Lymph Node 

Notes

Acknowledgment

The authors thank Kita Bogatch and the Melanoma Disease Management Team for their significant contributions to this study.

References

  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. Cancer J Clin. 2012;62:10–29.Google Scholar
  2. 2.
    Bristow I, Acland K. Acral lentiginous melanoma of the foot and ankle: a case series and review of the literature. J Foot Ankle Res. 2008;1:11.PubMedCrossRefGoogle Scholar
  3. 3.
    Piliang MP. Acral lentiginous melanoma. Clin Lab Med. 2011;31:281–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Reed R. New concepts in surgical pathology of the skin. New York: Wiley; 1976.Google Scholar
  5. 5.
    Bradford PT, Goldstein AM, McMaster ML, Tucker MA. Acral lentiginous melanoma: incidence and survival patterns in The United States, 1986–2005. Arch Dermatol. 2009;145:427–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Wu X-C, Eide MJ, King J, Saraiya M, Huang Y, Wiggins C, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999–2006. J Am Acad Dermatol. 2011;65:S26–37.PubMedCrossRefGoogle Scholar
  7. 7.
    Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, et al. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc. 2007;82:364–80.PubMedGoogle Scholar
  8. 8.
    Collins KK, Fields RC, Baptiste D, Liu Y, Moley J, Jeffe DB. Racial differences in survival after surgical treatment for melanoma. Ann Surg Oncol. 2011;18:2925–36.PubMedCrossRefGoogle Scholar
  9. 9.
    Green A, McCredie M, MacKie R, Giles G, Young P, Morton C, et al. A case-control study of melanomas of the soles and palms (Australia and Scotland). Cancer Causes Control. 1999;10:21–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Bormann G, Marsch WC, Haerting J, Helmbold P. Concomitant traumas influence prognosis in melanomas of the nail apparatus. Br J Dermatol. 2006;155:76–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Rolón PA, Kramárová E, Rolón HI, Khlat M, Parkin DM. Plantar melanoma: a case-control study in Paraguay. Cancer Causes Control. 1997;8:850–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol. 2006;155:561–9.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Leary JA, Berend KR, Johnson JL, Levin LS, Seigler HF. Subungual melanoma: a review of 93 cases with identification of prognostic variables. Clin Orthop Relat Res. 2000;(378):206–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Pollack LA, Li J, Berkowitz Z, Weir HK, Wu XC, Ajani UA, et al. Melanoma survival in The United States, 1992 to 2005. J Am Acad Dermatol. 2011;65(5 Suppl 1):S78–86.PubMedGoogle Scholar
  15. 15.
    Kuchelmeister C, Schaumburg-Lever G, Garbe C. Acral cutaneous melanoma in Caucasians: clinical features, histopathology and prognosis in 112 Patients. Br J Dermatol. 2000;143:275–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Slingluff CL, Vollmer R, Seigler HF. Acral melanoma: a review of 185 patients with identification of prognostic variables. J Surg Oncol. 1990;45:91–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Tan K-B, Moncrieff M, Thompson JF, McCarthy SW, Shaw HM, Quinn MJ, et al. Subungual melanoma: a study of 124 cases highlighting features of early lesions, potential pitfalls in diagnosis, and guidelines for histologic reporting. Am J Surg Pathol. 2007;31:1902–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Balch CM, Gershenwald JE, Soong S-J, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRefGoogle Scholar
  19. 19.
    Klein J, Moeschberger M. Techniques for censored and truncated data. New York: Springer; 2003.Google Scholar
  20. 20.
    Moehrle M, Metzger S, Schippert W, Garbe C, Rassner G, Breuninger H. “Functional” surgery in subungual melanoma. Dermatol Surg. 2003;29:366–74.PubMedCrossRefGoogle Scholar
  21. 21.
    Barnes BC, Seigler HF, Saxby TS, Kocher MS, Harrelson JM. Melanoma of the foot. J Bone Joint Surg Am. 1994;76:892–8.PubMedGoogle Scholar
  22. 22.
    Durbec F, Martin L, Derancourt C, Grange F. Melanoma of the hand and foot: epidemiological, prognostic and genetic features. A systematic review. Br J Dermatol. 2012;166:727–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Heaton K, El-Naggar A, Ensign L, Ross M, Balch C. Surgical management and prognostic factors in patients with subungual melanoma. Ann Surg. 1994;219:197–204.PubMedCrossRefGoogle Scholar
  24. 24.
    Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (>or = 4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRefGoogle Scholar
  26. 26.
    Yee VS, Thompson JF, McKinnon JG, Scolyer RA, Li LX, McCarthy WH, et al. Outcome in 846 cutaneous melanoma patients from a single center after a negative sentinel node biopsy. Ann Surg Oncol. 2005;12:429–39.PubMedCrossRefGoogle Scholar
  27. 27.
    Scolyer RA, Thompson JF, Stretch JR, Sharma R, McCarthy SW. Pathology of melanocytic lesions: new, controversial, and clinically important issues. J Surg Oncol. 2004;86:200–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Egger ME, McMasters KM, Callender GG, Quillo AR, Martin RC 2nd, Stromberg AJ, et al. Unique prognostic factors in acral lentiginous melanoma. Am J Surg. 2012;204:874–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Rex J, Paradelo C, Mangas C, Hilari JM, Fernandez-Figueras MT, Ferrandiz C. Management of primary cutaneous melanoma of the hands and feet: a clinicoprognostic study. Dermatol Surg. 2009;35:1505–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Krauthammer M, Kong Y, Ha BH, Evans P, Bacchiocchi A, McCusker JP, et al. Exome sequencing identifies recurrent somatic RAC1 mutations in melanoma. Nat Genet. 2012;44:1006–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Curtin JA, Fridlyand J, Kageshita T, Patel HN, Busam KJ, Kutzner H, et al. Distinct sets of genetic alterations in melanoma. N Engl J Med. 2005;353:2135–47.PubMedCrossRefGoogle Scholar
  32. 32.
    Furney SJ, Turajlic S, Fenwick K, Lambros MB, MacKay A, Ricken G, et al. Genomic characterisation of acral melanoma cell lines. Pigment Cell Melanoma Res. 2012;25:488–92.PubMedCrossRefGoogle Scholar
  33. 33.
    Curtin JA, Busam K, Pinkel D, Bastian BC. Somatic activation of KIT in distinct subtypes of melanoma. J Clin Oncol. 2006;24:4340–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Turajlic S, Furney SJ, Lambros MB, Mitsopoulos C, Kozarewa I, Geyer FC, et al. Whole genome sequencing of matched primary and metastatic acral melanomas. Genome Res. 2012;22:196–207.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Danielle M. Bello
    • 1
  • Joanne F. Chou
    • 3
  • Katherine S. Panageas
    • 3
  • Mary S. Brady
    • 1
  • Daniel G. Coit
    • 1
  • Richard D. Carvajal
    • 2
  • Charlotte E. Ariyan
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Medical OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations