Analysis of Recurrence Patterns in Acral versus Non-Acral Melanoma: Should Histologic Subtype Influence Treatment Guidelines?
| Autor: | Richard L. Shapiro, Nathaniel H. Fleming, Iman Osman, Russell S. Berman, Jennifer A. Stein, Judy Zhong, Priyanka Gumaste, Ines Pires da Silva |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Skin Neoplasms Guidelines as Topic Ajcc stage Kaplan-Meier Estimate Acral lentiginous melanoma Article Disease-Free Survival Internal medicine medicine Humans Surgical treatment neoplasms Melanoma Aged Aged 80 and over Locoregional failure integumentary system business.industry Significant difference Hazard ratio fungi Melanoma stage Middle Aged medicine.disease Prognosis Dermatology Surgery Acral melanoma Female Neoplasm Recurrence Local business |
| Popis: | Current surgical treatment of primary melanoma is uniform for all histosubtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), have a worse prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines for managing ALM compared with nonacral melanoma (NAM). Study subjects were identified from a prospectively enrolled database of patients with primary melanoma at New York University. Patients with ALM were matched to those with NAM (1:3) by gender and melanoma stage, including substage (ALM, 61; NAM, 183). All patients received standard-of-care treatment. Recurrence and survival outcomes in both cohorts were compared. ALM histologic subtype was an independent negative predictor of recurrence-free survival (hazard ratio [HR], 2.24; P=.001) and melanoma-specific survival (HR, 2.58; P=.001) compared with NAM. Recurrence was significantly more common in patients with ALM than in those with NAM (49% vs 30%; P=.007). For tumors less than 2 mm in thickness, a significantly higher recurrence rate was seen with ALM versus NAM (P=.048). No significant difference was seen in recurrence for tumors greater than 2 mm (P=.12). Notably, the rate of locoregional recurrence was nearly double for ALM compared with NAM (P=.001). The data presented herein reveal a high rate of locoregional failure in ALM compared with NAM when controlling for AJCC stage. These results raise the question of whether ALM may require more aggressive surgical treatment than nonacral cutaneous melanomas of equal thickness, particularly in tumors less than 2 mm thick. Larger multicenter trials are necessary for further conclusions. |
| Databáze: | OpenAIRE |
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