Caucasians with acral lentiginous melanoma have the same outcome as patients with stage- and limb-matched superficial spreading melanoma

Laura Susok,Thilo Gambichler

doi:10.1007/s00432-021-03630-6

Abstract

PurposeAcral lentiginous melanoma (ALM), a relatively rare subtype of cutaneous melanoma, has been reported to have a worse prognosis than other melanomas. We aimed to assess clinical findings in Caucasian ALM patients and compare the data with a matched cohort of superficial spreading melanoma (SSM) patients.MethodsWe studied 63 patients with ALM and 63 randomly stage- and limb-matched patients with SSM (non-ALM). In both cohorts, guideline-adjusted diagnosis, treatment and follow-up were performed.ResultsWe did not observe differences in prognostic factors (e.g., tumor thickness, ulceration) between the two cohorts. Both in ALM and non-ALM patients positive sentinel lymph node was a significant independent predictor for disease relapse and melanoma-specific death. However, disease relapse and melanoma-specific death rates did not significantly differ between ALM and non-ALM patients. An overall 5-year melanoma-specific survival of 82.5% and 81% was observed in ALM and non-ALM patients, respectively.ConclusionsOur data confirm that patients with ALM have no worse outcome than non-ALM patients when correcting for significant prognostic factors. Hence, the reportedly high rates of fatal ALM cases should not be ascribed to pathobiological differences between ALM and non-ALM but are most likely are a consequence of a delay in diagnosis and thus advanced stage of ALM.

Highlights

Acral lentiginous melanoma (ALM), occurring on the hands and feet was first defined as a distinct subtype of cutaneous melanoma (CM) by Arrington et al (1977)
Disease relapse was more likely observed in ALM (P = 0.016) as well as non-ALM (P = 0.018) patients who had a primary melanoma thicker than 2 mm
Unlike non-ALM patients, ALM patients with a primary thicker than 2 mm more likely died from melanoma (P = 0.029)

Summary

Introduction

Acral lentiginous melanoma (ALM), occurring on the hands and feet (palms, soles, fingers, toes, and nail units) was first defined as a distinct subtype of cutaneous melanoma (CM) by Arrington et al (1977). It is the least common subtype of CM comprising only about 2.5% of total melanoma diagnoses in Caucasians. The invasive portion of ALM usually resembles superficial spreading melanoma (SSM) and may secondarily develop a nodular growth pattern (Arrington et al 1977; BasurtoLozada et al 2021; Fernandez-Flores and Cassarino 2017; Hall and Rapini 2020)

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