Prognostics factors and survival in acral lentiginous melanoma

Abstract

Background

Acral lentiginous melanoma is a rare melanoma subtype that disproportionately afflicts people of color. Acral lentiginous melanomas have a worse prognosis than other melanomas subtypes, which has been attributed to aggressive biological behavior, more advanced stage at presentation and possible disparities in access to healthcare.

Objectives

Using comprehensive patient data and long-term follow-up information in a well-characterized cohort, to examine how patient, tumor, and clinical management variables impact overall and melanoma-specific survival.

Methods

We characterized a consecutive cohort of 123 acral lentiginous melanomas diagnosed from 1987-2013 and analyzed predictors of overall and melanoma-specific survival for their association with survival.

Results

Univariate hazard ratios and 95% confidence intervals using Cox regression models showed that increased Breslow depth, presence of ulceration, receipt of radiation, chemo- and vaccine therapy were associated with worse melanoma-specific survival. Notably, non-white race-ethnicity was not associated with worse overall or melanoma-specific survival. Multivariate modeling adjusting for patient, tumor, and management variables revealed Breslow depth greater than 2 millimeters and disease extent as significantly associated with poor melanoma-specific survival.

Conclusions

Melanoma-specific mortality among acral lentiginous melanomas patients is associated with increased tumor thickness and more advanced stage at presentation, but not race-ethnicity. Advanced tumor features at presentation and access to care may account for less favorable survival outcomes reported among non-white patients.

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