Kim Jina, Lee Dong-Youn, Mun Goo-Hyun, Lee Kyeong-Tae
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Surg Oncol. 2025 Mar;32(3):1473-1482. doi: 10.1245/s10434-024-16740-5. Epub 2024 Dec 23.
In the development of plantar melanoma, it is suspected that mechanical stress caused by weight-bearing activities, such as walking, rather than ultraviolet exposure, may play a significant role, showing a concentrated prevalence in areas of the foot where weight-bearing actions are prevalent. However, research investigating whether such mechanical stress influences disease prognosis has been limited. This study was designed to investigate the association between weight-bearing activity and the oncologic outcomes of patients with plantar melanoma.
Patients presenting primary foot melanoma without evidence of distant metastasis, who underwent surgical treatment from 2005 to 2022 were reviewed. They were divided into three groups based on the location of the melanoma: the weight-bearing-plantar, nonweight-bearing-plantar, and subungual/dorsal group and compared for the oncologic outcomes.
In total, 286 patients a mean age of 62.4 years were analyzed for a mean follow-up of 46 months, which included 168 (58.7%) in the weight-bearing-planar, 61 (21.3%) in the nonweight-bearing-plantar, and 57 (19.9%) in the subungual/dorsum. The baseline characteristics and pathologic staging, including Breslow thickness, were similar among the three groups. Surprisingly, in the comparison of oncologic outcomes, the nonweight-bearing-plantar group exhibited higher recurrence rates, especially for distant recurrence, and worse disease-free survival compared with the other two groups. This association remained significant after adjusting for other factors, including Breslow thickness, ulceration, and tumor staging.
Our findings suggest that while weight-bearing activity may be associated with the occurrence of acral melanoma, it may not act as a worsening factor in the progression of plantar melanoma.
在足底黑色素瘤的发展过程中，人们怀疑负重活动（如行走）所引起的机械应力而非紫外线暴露可能起重要作用，这表现为在足部负重活动频繁的区域患病率集中。然而，研究这种机械应力是否影响疾病预后的研究有限。本研究旨在调查负重活动与足底黑色素瘤患者肿瘤学结局之间的关联。
回顾了2005年至2022年接受手术治疗的原发性足部黑色素瘤且无远处转移证据的患者。根据黑色素瘤的位置将他们分为三组：负重足底组、非负重足底组和甲下/背侧组，并比较肿瘤学结局。
总共分析了286例平均年龄为62.4岁的患者，平均随访46个月，其中负重平面组168例（58.7%），非负重足底组61例（21.3%），甲下/背侧组57例（19.9%）。三组的基线特征和病理分期，包括Breslow厚度，相似。令人惊讶的是，在肿瘤学结局的比较中，非负重足底组与其他两组相比，复发率更高，尤其是远处复发率，且无病生存期更差。在调整包括Breslow厚度、溃疡和肿瘤分期等其他因素后，这种关联仍然显著。
我们的研究结果表明，虽然负重活动可能与肢端黑色素瘤的发生有关，但它可能不是足底黑色素瘤进展的恶化因素。
