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Prognostic factors and survival in acral lentiginous melanoma
Author(s) -
Asgari M.M.,
Shen L.,
Sokil M.M.,
Yeh I.,
Jorgenson E.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15600
Subject(s) - medicine , acral lentiginous melanoma , melanoma , proportional hazards model , hazard ratio , cohort , survival analysis , breslow thickness , oncology , cancer , multivariate analysis , confidence interval , breast cancer , sentinel lymph node , cancer research
Summary Background Acral lentiginous melanoma ( ALM ) is a rare melanoma subtype that disproportionately afflicts people of colour. ALM s have a worse prognosis than other melanoma subtypes; this has been attributed to aggressive biological behaviour, more advanced stage at presentation and possible disparities in access to health care. Objectives To examine, using comprehensive patient data and long‐term follow‐up information in a well‐characterized cohort, how patient, tumour and clinical management variables impact overall and melanoma‐specific survival. Methods We characterized a consecutive cohort of 123 ALM s diagnosed from 1987 to 2013 and analysed predictors of overall and melanoma‐specific survival for their association with survival. Results Univariate hazard ratios and 95% confidence intervals using Cox regression models showed that increased Breslow depth, presence of ulceration, receipt of radiation, chemo‐ and vaccine therapy were associated with worse melanoma‐specific survival. Notably, nonwhite race/ethnicity was not associated with worse overall or melanoma‐specific survival. Multivariate modelling adjusting for patient, tumour and management variables revealed Breslow depth > 2 mm and disease extent as significantly associated with poor melanoma‐specific survival. Conclusions Melanoma‐specific mortality among patients with ALM is associated with increased tumour thickness and more advanced stage at presentation, but not with race/ethnicity. Advanced tumour features at presentation and access to care may account for less favourable survival outcomes reported among nonwhite patients.