title: Analysis of recurrence patterns in acral versus nonacral melanoma: should histologic subtype influence treatment guidelines?
abstract: 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.
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Priyanka V
authors.initials: PV
authors.lastname: Gumaste
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Nathaniel H
authors.initials: NH
authors.lastname: Fleming
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Ines
authors.initials: I
authors.lastname: Silva
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Shapiro
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Berman
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Judy
authors.initials: J
authors.lastname: Zhong
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Iman
authors.initials: I
authors.lastname: Osman
authors.affiliation: From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York. From the Interdisciplinary Melanoma Cooperative Group; and Ronald O. Perelman Department of Dermatology, and Departments of Medicine and Surgery, New York University School of Medicine, New York, New York.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012878:Skin Neoplasms; D000096142:Cutaneous Malignant Melanoma