title: Acral lentiginous melanoma: a clinicoprognostic study of 126 cases.
abstract: BACKGROUND
  Although the histopathological subtype of melanoma has not been clearly proven to carry independent prognostic significance, acral lentiginous melanoma (ALM) seems to confer a poorer prognosis mainly because disease is often more advanced at the time of diagnosis.
  
  
  OBJECTIVE
  To investigate the distinctive epidemiological and clinical characteristics of ALM, a peculiar histological entity, and to identify prognostic factors.
  
  
  METHODS
  We performed a register-based review of cases from a single large referral centre, the University Hospital Department of Dermatology, Lyons, France. We reviewed patient demographics, the initial presentation of the lesion, and clinical outcome. ALM-specific and disease-free survival were estimated using the KaplanMeier method and compared using the log-rank test. A Cox model was used to identify prognostic factors.
  
  
  RESULTS
  One hundred and twenty-six patients were identified as having histopathology-proven ALM in our melanoma patient register from 1996 to 2004. There were 46 (37%) subungual ALM and 80 (63%) ALM on soles, palms and nonvolar sites. The mean age at diagnosis was 63 years. There were 44 (35%) men and 82 (65%) women, sex ratio M/F 1 : 1.86. The mean Breslow thickness was 2.51 mm (range: in situ to 20 mm). There was no evidence of overexposure to ultraviolet radiation, nor was there found a predisposing genetic trait. Only 16 (13%) patients recalled a history of trauma. Thirty-four ALM (28%) were unpigmented. The median ALM-specific and disease-free survival were 13.5 and 10.1 years, respectively. The 5-year survival rate was 76%. Multivariate analysis identified tumour thickness, male gender and amelanosis as independent clinical prognostic factors for both ALM-specific and disease-free survival.
  
  
  CONCLUSIONS
  Our study provides specific information on the clinical characteristics and outcome of this uncommon histological subtype of melanoma. However, the pathogenesis remains unknown. Breslow thickness, male gender and amelanosis were significantly associated with a poorer prognosis.
authors.affiliation: Department of Dermatology, Hôtel Dieu, Claude Bernard University, 69288 Lyon cedex 02, France.
authors.forename: A
authors.initials: A
authors.lastname: Phan
authors.forename: S
authors.initials: S
authors.lastname: Touzet
authors.forename: S
authors.initials: S
authors.lastname: Dalle
authors.forename: S
authors.initials: S
authors.lastname: Ronger-Savlé
authors.forename: B
authors.initials: B
authors.lastname: Balme
authors.forename: L
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D005534:Foot Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005602:France / Q000453:epidemiology; D020022:Genetic Predisposition to Disease; D006225:Hand; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D009042:Motivation; D009260:Nail Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D017678:Sex Distribution; D012867:Skin / Q000293:injuries; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D014466:Ultraviolet Rays / Q000009:adverse effects