title: Acral Lentiginous Melanoma - misdiagnosis, referral delay and 5 years specific survival according to site.
abstract: OBJECTIVE
  Acral lentiginous melanoma (ALM) is a defined histopathological entity with peculiar clinical-pathological features and is the most common subtype of malignant melanoma in acral locations. The 5-year survival rate is lower than that for all cutaneous malignant melanoma overall (80.3% versus 91.3%). Controversy exists in the literature as to whether this worse prognosis is attributable to a more aggressive biological nature or to difficult-to-see sites and consequent advanced stage at the time of diagnosis. The main purpose of the study was to explore any prognostic difference according to upper limb or lower limb localizations, based on the hypothesis that upper limb localizations might receive attention sooner than lower limb localizations.
  
  
  METHODS
  A cohort longitudinal study was performed through a retrospective review of all patients consecutively referred to our Unit with histological confirmation of ALM. Data were collected from a 10 year period between 1996 and 2006 to allow determination of 5 year survival statistics.
  
  
  RESULTS
  Out of 87 patients included in the study, 32 were men (37%) and 55 were women 63%. The average number of months it took for patients to present was 62 months with a mode of 12 months. Overall 5 year survival was 80% and a multivariate analysis showed that the most reliable prognostic indicators are the Breslow's thickness and the margins of complete excision. When controlling the survival rates for Breslow thickness, the values were similar to the reported rates indicated in the recent literature for cutaneous malignant melanoma.
  
  
  CONCLUSIONS
  The higher aggressiveness of ALM was noticed to be attributable to a later stage and more advanced thickness at diagnosis. No significant difference was found between upper and lower limb localization in terms of prognosis.
authors.affiliation: Department of Plastic Surgery, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, United Kingdom. borianifilippo@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Boriani
authors.forename: F
authors.initials: F
authors.lastname: O'Leary
authors.forename: M
authors.initials: M
authors.lastname: Tohill
authors.forename: A
authors.initials: A
authors.lastname: Orlando
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D000096142:Cutaneous Malignant Melanoma