Abstract
BackgroundAcral and mucosal melanomas are rarely seen in Caucasians but common in China. There are limited data on the recurrence characteristics for these patients. This study aimed to identify the recurrence pattern for localized melanoma in China, especially acral and mucosal subtypes.MethodsPatients with localized melanoma who underwent radical resection between January 1999 and December 2014 in southern China were retrospectively reviewed. Survival and annual recurrence hazard were analyzed by Kaplan–Meier method and hazard function, respectively.ResultsTotally, 1012 patients were included (acral melanoma 400; chronic sun-induced damage (CSD)/non-CSD melanoma 314; mucosal melanoma 298). Recurrence was recorded in 808 patients (localized 14.1%; regional 29.6%, and distant 56.3%). Mucosal melanoma had local and M1c stage recurrence more frequently than cutaneous melanoma, but less frequent regional node relapse. There was no difference in recurrent site distribution between acral and CSD/non-CSD melanoma. The annual recurrence hazard curve for the entire cohort showed a double-peaked pattern with the first major peak in the second year after surgery and the second peak near the seventh year. Mucosal melanoma had a higher recurrence risk than cutaneous melanoma. Acral melanoma had a lower flat recurrence peak than CSD/non-CSD melanoma. Tumor thickness > 4.0 mm, ulceration, positive regional nodes, and wound infection were associated with a higher recurrence risk in cutaneous melanoma. Adjuvant therapy reduced the recurrence risk of cutaneous melanoma but not of mucosal melanoma.ConclusionsThis is a large cohort about the rule of recurrence risk in acral and mucosal melanoma and will provide an initial framework for development of surveillance and adjuvant strategy for Chinese melanoma patients.
Highlights
Malignant melanoma is a heterogenous group of melanocytic neoplasms diagnosed in approximately 20,000 people annually in China [1]
There were 298 patients with mucosal melanoma included in this study, accounting for 29.4% of all patients
When the hazard rate was related to primary tumor subtype, the analysis showed that mucosal melanoma had a higher recurrence risk than acral or non-acral cutaneous melanoma throughout the observation period
Summary
Malignant melanoma is a heterogenous group of melanocytic neoplasms diagnosed in approximately 20,000 people annually in China [1]. In the Chinese population, melanoma arising from the skin accounts for between 50 and 70%, with the acral areas being the most common primary sites. Mucosal melanoma is the second most common subtype, with a percentage incidence of between 22 and 25% [4]. For Caucasians, approximately 90% of melanoma arise from the skin, commonly on skin of nonacral sites, while melanoma arising from the mucous membranes and acral areas account for between 1 and 5% [5]. Acral and mucosal melanomas have been reported to have distinct genetic and clinical characteristics and a poorer prognosis [6,7,8,9]. Acral and mucosal melanomas are rarely seen in Caucasians but common in China. This study aimed to identify the recurrence pattern for localized melanoma in China, especially acral and mucosal subtypes
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