Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
JAMA Dermatol. 2013 Nov;149(11):1281-8. doi: 10.1001/jamadermatol.2013.5853.
The pathogenesis of acral melanoma remains unclear, even though trauma may be a predisposing factor. A study about the association of long-term physical stress with the incidence and spreading patterns through detailed anatomic mapping may be important to understand the unique features of acral melanoma.
To analyze the epidemiologic and clinicopathologic characteristics of acral melanoma and evaluate how long-term physical stress or pressure strength influences acral melanoma based on the analysis of differences in incidence, prognosis of the distinct site (weight or non-weight-bearing portion of sole, volar, or subungual location), and the spreading pattern of melanoma on the soles.
DESIGN, SETTING, AND PATIENTS: Cross-sectional, retrospective study of 177 Korean patients with acral melanoma from January 1, 1994, through October 31, 2012.
Anatomic mapping and histopathologic examination of acral melanoma. RESULTS The male to female ratio was 1:1.03, and the mean age at first admission was 55.3 years. Acral lentiginous melanoma was the most common histopathologic subtype (85.9%), followed by nodular melanoma (12.8%). There was a high incidence of acral melanoma at more physically stressed sites, such as the center of the heels and inner forefoot. In addition, a peculiar spreading pattern with the long axis of melanoma, typically along naturally occurring creases due to long-term pressure on the soles, was often observed. The prognostic index and survival rate showed no significant difference between volar and subungual locations or between weight and non-weight-bearing portions of the soles.
Clinicopathologic characteristics of acral melanoma diagnosed at an advanced stage and resulting in a low survival rate are not significantly different between Koreans and other Asians. Interestingly, based on our study, long-term physical stress or pressure strength can influence the incidence and spreading pattern of acral melanoma in a particular manner. Acral melanoma occurs on more physically stressed sites with the long axis along natural creases on the sole. A further prospective investigation, especially of in situ lesions, regarding location-based differences in incidence, progress, and survival is necessary to better understand the pathophysiologic characteristics of acral melanoma.
肢端黑色素瘤的发病机制仍不清楚，尽管创伤可能是一个诱发因素。一项关于长期身体应激与发病率和通过详细解剖映射传播模式之间关联的研究，对于了解肢端黑色素瘤的独特特征可能很重要。
分析肢端黑色素瘤的流行病学和临床病理特征，并评估长期身体应激或压力强度如何影响肢端黑色素瘤，基于对发病率、不同部位（足底承重或非承重部分、掌侧或甲下位置）的预后以及足底黑色素瘤的扩散模式的差异进行分析。
设计、设置和患者：回顾性横断面研究，纳入了 1994 年 1 月 1 日至 2012 年 10 月 31 日期间的 177 名韩国肢端黑色素瘤患者。
肢端黑色素瘤的解剖映射和组织病理学检查。结果：男女比例为 1:1.03，首次就诊时的平均年龄为 55.3 岁。最常见的组织病理学亚型是肢端雀斑样黑色素瘤（85.9%），其次是结节性黑色素瘤（12.8%）。肢端黑色素瘤高发于身体压力更大的部位，如脚跟中心和前脚内侧。此外，还经常观察到一种独特的扩散模式，黑色素瘤的长轴通常沿着足底长期受压形成的自然褶皱。掌侧和甲下位置或足底承重和非承重部分之间的预后指数和生存率无显著差异。
韩国人与其他亚洲人相比，晚期诊断和生存率低的肢端黑色素瘤的临床病理特征无显著差异。有趣的是，根据我们的研究，长期身体应激或压力强度可以以特定的方式影响肢端黑色素瘤的发病率和扩散模式。肢端黑色素瘤发生在身体压力更大的部位，长轴沿着足底的自然褶皱延伸。为了更好地了解肢端黑色素瘤的病理生理特征，有必要对基于位置的发病率、进展和生存率差异进行进一步的前瞻性研究，特别是对原位病变的研究。
