Abstract
Introduction. Cutaneous foot melanoma is rare, challenging to manage, and not adequately examined in the literature. This study evaluated the prognostic variables and surgical management of foot melanoma. Materials and Methods. Foot melanoma cases managed at an academic center from 1985 to 2010 were retrospectively reviewed. Results. 46 patients were identified with a broad range of demographic characteristics. Overall recurrence was 32.6%: 19% acral lentiginous, 57% nodular, 66% superficial spreading, 30% melanoma unspecified, 50% severely atypical; 53% ulcerated, 23% nonulcerated; 29% on the dorsum of the foot, 17% heel, 60% ankle, 22% toe, 50% plantar; 0% <1 mm thick, 47% 1–4 mm, 33% >4 mm. 13 had positive nodes, 4 (31%) of whom recurred. Prognostic factors and recurrence did not correlate, and survival was 96% with a median followup of 91 months. Conclusions. Aggressive management of foot melanoma may result in excellent long-term survival even following disease recurrence.
Highlights
Cutaneous foot melanoma is rare, challenging to manage, and not adequately examined in the literature
Clinicians have focused on clinical factors, histology, anatomic location, and the presence or absence of metastatic disease to determine the prognosis of patients with melanoma [3, 6]
This argument was even further applied to distinguish between the prognosis of melanoma arising on the dorsum of the foot versus the plantar aspect of the foot based on the variable thickness of the skin and the variable density of vascular and lymphatic networks between these sites [3]; there is no consensus in the literature regarding the variables that predict prognosis and, which should guide the management of foot melanoma
Summary
Malignant melanoma represents a major public health concern worldwide and the annual incidence has been steadily rising since 1935 [1]. There has been great variability in the factors that the literature has analyzed, even in regard to such clinically significant considerations as pathology, thickness, lymph node status, metastasis, recurrence, and survival This retrospective study was performed to review the prognostic variables, management, and outcomes of foot melanoma to try to arrive at surgical guidelines. Patients treated for cutaneous melanoma of the foot from 1985 to 2010 at the Virginia Commonwealth University Health System were retrospectively reviewed for demographic data, histology, anatomic location, Breslow thickness, mitotic index, ulceration, operation, surgical margin, lymph node status, location of recurrence, disease-free survival, and overall survival.
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