Nunes Luiz F, Quintella Mendes Gélcio L, Koifman Rosalina J
Brazilian National Cancer Institute-INCA-Cancer Hospital II.
Oswaldo Cruz Foundation/National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil.
Melanoma Res. 2018 Oct;28(5):458-464. doi: 10.1097/CMR.0000000000000476.
Acral melanoma (AM) is a rare subtype of melanoma arising on the palms, soles and subungual areas. In the Brazilian and Latin American populations, the sociodemographic and clinical-pathologic features of AM are unclear. AM tends to be more advanced at presentation because of delayed diagnoses, with poor survival. This study reports on a retrospective AM cohort from the Brazilian National Cancer Institute. We reviewed a database of 529 patients presenting with AM from 1997 to 2014 and analysed the sociodemographic and clinical-pathologic features of AM associated with overall survival and relapse-free survival. All patients were Brazilian, ranging in age from 19 to 101 years (mean 65.4; median 67.0). Two hundred and ninety-four (55.8%) patients were women. The Breslow primary lesion thicknesses ranged from 0.0 to 65.0 mm (mean 8.3 mm; median 5.0 mm). Of these patients, 43.3% had the acral lentiginous histologic subtype. Plantar was the most frequently involved site (68.5%), and ulcers and mitosis were present in 79.0 and 86.4% of these cases, respectively. Multivariate analysis results found that Breslow thickness of 1.03 (95% confidence interval: 1.01-1.05; P=0.01) and ulceration of 2.70 (95% confidence interval: 1.00-7.06; P=0.05) were poor prognostic indicators of overall survival. AM tumours were thick on diagnostic tests and were associated with poorer survival outcomes. Unfavourable prognosis likely derives from the delayed diagnosis compared with other melanoma subtypes.
肢端黑色素瘤（AM）是一种罕见的黑色素瘤亚型，发生于手掌、足底和甲下区域。在巴西和拉丁美洲人群中，AM的社会人口统计学和临床病理特征尚不清楚。由于诊断延迟，AM在就诊时往往病情更严重，生存率较低。本研究报告了巴西国家癌症研究所的一个AM回顾性队列。我们回顾了1997年至2014年529例AM患者的数据库，并分析了与总生存期和无复发生存期相关的AM社会人口统计学和临床病理特征。所有患者均为巴西人，年龄在19岁至101岁之间（平均65.4岁；中位数67.0岁）。294例（55.8%）患者为女性。Breslow原发灶厚度范围为0.0至65.0毫米（平均8.3毫米；中位数5.0毫米）。这些患者中，43.3%具有肢端雀斑样组织学亚型。足底是最常受累的部位（68.5%），这些病例中分别有79.0%和86.4%存在溃疡和核分裂象。多变量分析结果发现，Breslow厚度为1.03（95%置信区间：1.01 - 1.05；P = 0.01）和溃疡为2.70（95%置信区间：1.00 - 7.06；P = 0.05）是总生存期的不良预后指标。AM肿瘤在诊断检查时厚度较大，且与较差的生存结果相关。与其他黑色素瘤亚型相比，预后不良可能源于诊断延迟。
