Nagore Eduardo, Pereda Carolina, Botella-Estrada Rafael, Requena Celia, Guillén Carlos
Department of Dermatology, Instituto Valenciano de Oncología, Avda. Barón de Cárcer, 42-17, 46001, Valencia, Spain.
Cancer Causes Control. 2009 Feb;20(1):115-9. doi: 10.1007/s10552-008-9221-y. Epub 2008 Aug 29.
Acral lentiginous melanoma (ALM) is a distinct histological variant of cutaneous melanoma that presents a genomic profile different from the other variants. Our aim was to explore the distinctive clinical, pathological, and epidemiological characteristics of ALM.
A series of 978 patients with primary cutaneous melanoma was selected from a single referral center. Among these, 79 were located on acral sites and 46 presented an ALM. This group was compared with a group composed of 932 patients with the remaining three most frequent cutaneous melanoma variants.
The ALM differed significantly from other variants: in an older age at diagnosis (65.52 vs. 51.79 years), a lower number of common (88.2 vs. 55.8%) and atypical nevi (95.0 vs. 80.2%), a predisposing genetic trait to cancer (22.2 vs. 7.1% had a personal history of other non-cutaneous malignancies and 58.1 vs. 36.4% had at least one first degree relative with non-cutaneous neoplasia) and lower number of sunburns (88.2 vs. 47.4% remembered none). Also, the tumors were thicker (mean of 2.94 vs. 2.03 mm), more frequently ulcerated (74.2 vs. 23.9%) and with perineural invasion (8.0 vs. 1.5%), had lower degree of inflammatory infiltrate (36.8 vs. 7.5% was absent) and were less frequently associated with a previous melanocytic lesion (8.3 vs. 32.6%). Differences were kept even after age-adjusted analyses.
Our results, from a clinical and epidemiological point of view, support recent data on genetic characterization of melanomas. In comparison with the other frequent variants we have shown that ALM has some important differences which emphasize that it is a distinct entity more probably related to certain cancer susceptibility but unrelated to familial melanoma, tendency to developing nevus or sun exposure.
肢端雀斑样痣黑色素瘤（ALM）是皮肤黑色素瘤一种独特的组织学变体，其基因组图谱与其他变体不同。我们的目的是探究ALM独特的临床、病理和流行病学特征。
从一个单一的转诊中心选取了978例原发性皮肤黑色素瘤患者。其中，79例位于肢端部位，46例为ALM。将该组与由932例其他三种最常见皮肤黑色素瘤变体患者组成的组进行比较。
ALM与其他变体有显著差异：诊断时年龄较大（65.52岁对51.79岁），普通痣（88.2%对55.8%）和非典型痣数量较少（95.0%对80.2%），有癌症易感遗传特征（有其他非皮肤恶性肿瘤个人史的比例为22.2%对7.1%，至少有一位一级亲属患有非皮肤肿瘤的比例为58.1%对36.4%），晒伤次数较少（88.2%对47.4%记不起有晒伤）。此外，肿瘤更厚（平均2.94毫米对2.03毫米），溃疡更频繁（74.2%对23.9%）且有神经周围侵犯（8.0%对1.5%），炎症浸润程度较低（无炎症浸润的比例为36.8%对7.5%），与先前黑素细胞病变的关联较少（8.3%对32.6%）。即使在年龄调整分析后差异仍然存在。
从临床和流行病学角度来看，我们的结果支持了近期关于黑色素瘤基因特征的数据。与其他常见变体相比，我们表明ALM有一些重要差异，这强调它是一个独特的实体，更可能与某些癌症易感性相关，但与家族性黑色素瘤、痣的形成倾向或日晒无关。
