Abstract
The pathogenesis of melanomas emerging in plantar surfaces remains unclear; however, mechanical stress has been reported to increase the formation of melanomas. In this study, we conducted a multicenter retrospective analysis of 153 acral melanomas diagnosed between 2000 and 2015 in Taiwan. The male-to-female ratio of the patients in question was 1:1.28, and the mean age at diagnosis was 68 years. We examined whether melanomas which developed in different areas of the patients’ soles differed in their associations with various clinicopathological characteristics and survival. Testing by goodness of fit indicated that stress-bearing areas were significantly more conducive to the generation of melanomas than non-stress-bearing areas (P < 0.0001). More specifically, compared to the arch, the rear of the foot and front of the foot were significantly more conducive to the generation of melanomas (P < 0.0001 and P < 0.0001, respectively). The distribution pattern was not associated with differences in age, gender, right/left foot involvement, ulceration, mitosis, lymph node metastasis, tumor thickness, or stage. The overall, distant metastasis-free, and recurrence-free survival rates did not differ significantly between the stress-bearing and non-stress-bearing areas. Furthermore, while acral melanomas tended to develop on stress-bearing areas, the distribution pattern was not associated with the prognostic index or survival.
Highlights
In Asia, over half of all melanomas are acral melanomas[1]
Surfaces were observed in the following frequencies: 83.0% were located on soles and 17.0% were located on toes
13.1% of the cases presented melanoma in situ, 68.6% of the cases were at stage I or II, and 18.3% of the cases were at stage III or IV
Summary
In Asia, over half of all melanomas are acral melanomas[1]. Melanomas on sun-exposed areas are seen less frequently in Asians than in Caucasians2,3]. Ultraviolet radiation does not appear to be associated with melanomas in Asian populations[4]. The relevance of mechanical stress to acral melanomas has previously been reported with respect to Scots, Japanese, and Koreans patients[5,6,7]. No studies regarding the relationship between mechanical stress and acral melanomas in Taiwanese patients over a given time period have previously been reported. We established a clinical database of acral melanomas in Taiwanese patients and analyzed whether any differences in frequency and clinicopathological characteristics existed among melanomas that developed in different areas of the sole. The associations between the distribution pattern of the melanomas and the overall survival (OS), distant metastasis-free survival (DMFS), and recurrence-free survival (RFS) rates were evaluated[8,9,10,11]
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