Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA.
Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
Pigment Cell Melanoma Res. 2021 Nov;34(6):1049-1061. doi: 10.1111/pcmr.12999. Epub 2021 Aug 2.
Acral lentiginous melanoma (ALM) is a rare histological subtype of cutaneous malignant melanoma that typically presents on the palms and soles. To characterize the demographic and treatment characteristics of ALM, we used the National Cancer Database (NCDB) to describe a large multi-institutional cohort of ALM patients, consisting of 4,796 ALM patients from 2004 to 2015. ALM was more likely to be diagnosed at a later stage overall compared with non-ALM cutaneous melanomas, and more likely to be thicker, ulcerated, lymph node positive, and have lymphovascular invasion and positive margins. When stratified by stage, ALM had worse survival compared with non-ALM patients, most notably in stage III patients with 5-year survival of 47.5% versus 56.7%, respectively (p < .001). In ALM patients, older age, male sex, higher comorbidity burden, increased tumor thickness and ulceration, positive lymph nodes, and positive metastasis were independently associated with lower 5-year survival. Multimodality therapy, defined as surgery in addition to systemic therapy and/or radiation therapy, was associated with higher survival in stage III patients but not in other stages. These results call for further investigation into possible treatment intensification in the ALM population in the future.
肢端黑色素瘤（ALM）是一种罕见的皮肤恶性黑色素瘤组织学亚型，通常发生于手掌和足底。为了描述 ALM 的人口统计学和治疗特征，我们使用国家癌症数据库（NCDB）描述了一个大型多机构的 ALM 患者队列，其中包括 2004 年至 2015 年的 4796 例 ALM 患者。与非 ALM 皮肤黑色素瘤相比，ALM 总体上更有可能被诊断为晚期，并且更有可能厚度更大、溃疡、淋巴结阳性、存在淋巴血管侵犯和切缘阳性。按分期分层时，与非 ALM 患者相比，ALM 的生存率更差，尤其是在 III 期患者中，5 年生存率分别为 47.5%和 56.7%（p<.001）。在 ALM 患者中，年龄较大、男性、合并症负担较重、肿瘤厚度和溃疡增加、淋巴结阳性和转移阳性与较低的 5 年生存率独立相关。定义为手术联合系统治疗和/或放疗的多模态治疗与 III 期患者的生存率较高相关，但与其他分期无关。这些结果表明，未来需要进一步研究 ALM 人群中可能的治疗强化措施。
