Abstract
Background
Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous malignant
melanoma (CMM). We aimed to study the incidence and survival of ALM in the United
States in recent 10 y and compare the survival between ALM and nonacral CMM. In the
meantime, racial disparity and prognostic factors associated with survival were investigated.
Methods
All the cases of ALM registered in the Surveillance, Epidemiology, and End Results
registry from 2006 to 2015 were retrieved, including non-Hispanic whites (NHW), black
Americans (blacks), Asian/Pacific Islanders, and Hispanic whites. Age-adjusted incidence
was calculated. Clinicopathologic data, including age, gender, race, geographic location,
Breslow thickness, ulceration, pathologic staging, sentinel lymph node status, and
surgical approach, were collected and analyzed. Melanoma-specific survival (MSS) was
analyzed in patients with ALM and CMM. The Kaplan-Meier method was used to estimate
the influence of clinicopathologic data on ALM MSS. Only cases with complete staging
and active follow-up were included in prognostic factor analysis.
Results
A total of 1724 ALM and 87,442 nonacral CMM patients were included in the study. For
ALM patients, the age-adjusted incidence rate was 2.0 per million person-years. The
proportion of ALM among all melanoma subtypes was greatest in blacks (32.6%). The
5-y MSS rates of ALM were lower than CMM overall (80.6% versus 93.0%, P < 0.001, respectively). When controlled by stage, the difference was significant
in patients diagnosed at stages I and III. ALM 5-y MSS rates were highest (84.3%)
in NHW, intermediate in Asian/Pacific Islanders (76.6%), Hispanic white (72.0%), and
lowest in blacks (66.9%). Blacks were elderly, male predominant, located in East and
Middle American, and had thicker, more ulcerated, advanced disease as compared with
NHWs. When controlled by stage, survival difference was significant between NHWs and
blacks in stage I (P = 0.004) and stage III (P = 0.005) patients. Gender, race, sentinel lymph node status, and pathologic stage
were identified as independent risk factors in multivariate analysis.
Conclusions
The incidence of ALM has been steady in recent 10 y and more prevalent in aged people.
ALM is associated with a worse prognosis than CMM. Black Americans have the worst
prognosis, and survival difference is significant between NHW and blacks.
Keywords
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Article info
Publication history
Published online: March 21, 2020
Accepted:
February 16,
2020
Received in revised form:
January 13,
2020
Received:
October 13,
2019
Footnotes
This study has been presented at Society of Asian Academic Surgeons 2019 as a quick shot presentation.
Identification
Copyright
© 2020 Published by Elsevier Inc.
