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Piñero-Madrona A, Cerezuela-Fuentes P, Ruiz-Merino G, Martínez-Barba E, Ortiz-Reina S, Martínez-Ortiz MJ, López-Ávila A, Frías-Iniesta JF, Viney A, Cabezas-Herrera J. Lower limb cutaneous melanoma surgery: location matters. Arch Dermatol Res 2023; 315:1971-1978. [PMID: 36862181 PMCID: PMC10366258 DOI: 10.1007/s00403-023-02571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/21/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.Trial registration number NCT04625491 retrospectively registered.
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Affiliation(s)
- Antonio Piñero-Madrona
- Surgery Department, Hospital Clínico Universitario "Virgen de la Arrixaca", School of Medicine, University of Murcia, Campus de Ciencias de la Salud. Edificio Departamental, Office 4.27, 30120, Murcia, Spain.
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.
| | - Pablo Cerezuela-Fuentes
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
- Medical Oncology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | - Guadalupe Ruiz-Merino
- Biostatistics Department, Fundación para la Formación e Investigación Sanitaria de la Región de Murcia, Murcia, Spain
| | - Enrique Martínez-Barba
- Pathology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | | | | | - Angel López-Ávila
- Dermatology Department, Complejo Hospitalario de Cartagena, Cartagena, Spain
| | - José F Frías-Iniesta
- Dermatology Department, Hospital Clínico Universitario "Virgen de la Arrixaca", Murcia, Spain
| | - Alice Viney
- Pharmacy Department, Complejo Hospitalario de Cartagena, Cartagena, Spain
| | - Juan Cabezas-Herrera
- Research Department, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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2
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Kim JH, Lee CR, Kwon HJ, Oh DY, Jun YJ, Rhie JW, Moon SH. Two-team-approached free flap reconstruction for plantar malignant melanoma: An observational (STROBE-compliant) trial. Medicine (Baltimore) 2022; 101:e29442. [PMID: 35905277 PMCID: PMC9333463 DOI: 10.1097/md.0000000000029442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Reconstructive treatments of heel defects usually involve regional flap techniques such as medial plantar flap procedures due to the limited availability of adjacent soft tissues. Although free flaps have advantages in terms of function and aesthetics, they remain challenging due to the longer operation time required than for regional flaps. Thus, we introduce an appropriate 2-team surgical protocol to reconstruct plantar defects after wide excision of malignant melanoma using free flap coverage. From 2015 to 2020, a retrospective study was performed including 21 patients who underwent free flap surgeries to reconstruct defects due to plantar malignant melanoma. Lymphoscintigraphy was performed to localize sentinel lymph nodes, and the procedure was carried out by 2 teams working together, a tumor-ablative team and a reconstructive team. The present study is adhered to the STROBE guidelines for cohort studies. The average operation time was 241.4 minutes and was not significantly different even in cases with inguinal dissection (P value: 0.641). All flaps survived after 2 cases of venous insufficiency and 1 case of hematoma were resolved by immediate revision surgery. The 2-team approach to surgically reconstruct heel defects after wide excision of malignant melanoma using free flap coverage offers favorable results and lower morbidity than regional flap approaches.
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Affiliation(s)
- Jun Hyeok Kim
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chae Rim Lee
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo Jeong Kwon
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deuk Young Oh
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Joon Jun
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Won Rhie
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Ho Moon
- Department of Plastic & Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Suk-Ho Moon, Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea (e-mail: )
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3
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An M, Blekher L, Liu M, Pitre M, Shaner R, Silva D, Vlahovic TC. Plantar Melanoma: An Investigation of Its Incidence. Clin Podiatr Med Surg 2021; 38:595-599. [PMID: 34538438 DOI: 10.1016/j.cpm.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melanoma accounts for more than 100,000 new cancer cases each year, and a minority (3%-15%) involve the foot and ankle. Case studies and isolated data set analyses report infrequent plantar melanomas, with these tumors more commonly encountered in non-whites. The absolute incidence of plantar melanoma is approximately the same in all races, but it is a more common type of cutaneous melanoma in non-white populations. Plantar melanoma is more prevalent in women, potentially a result of increased inflammation from uncomfortable shoes. When presenting on the plantar surface of the foot, features atypical of classic cutaneous melanoma are often present.
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Affiliation(s)
- Michael An
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Lev Blekher
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Meng Liu
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Matthew Pitre
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Ryan Shaner
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Daryl Silva
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA
| | - Tracey C Vlahovic
- Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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4
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Jung JM, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Lymphatic invasion in acral and non-acral melanoma: a comparative, clinicoprognostic study of primary cutaneous melanoma according to tumour site. Pathology 2020; 52:670-675. [PMID: 32819739 DOI: 10.1016/j.pathol.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/07/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022]
Abstract
There have been limited studies comparing the clinical significance of lymphatic invasion in melanoma according to tumour site. The objective of this study was to evaluate the impact of lymphatic invasion on the clinicoprognostic features of acral and non-acral melanoma. Clinical and histopathological features and survival outcomes of 532 patients with acral melanoma or non-acral melanoma in the database of the Asan Medical Center, Korea, were retrospectively evaluated according to the presence of lymphatic invasion. Lymphatic invasion was significantly more common in acral melanoma than non-acral melanoma. In acral melanoma, lymphatic invasion was significantly associated with a higher frequency of lymph node involvement and advanced stages, but not associated with Breslow thickness or visceral dissemination. By contrast, lymphatic invasion in non-acral melanoma was significantly associated with a higher rate of visceral involvement, deeper Breslow thickness, as well as a higher rate of lymph node involvement and advanced stages. When acral melanoma and non-acral melanoma both with lymphatic invasion were compared, Breslow thickness was significantly shallower and vertical growth phase was significantly less common in acral melanoma. Meanwhile, visceral involvement was significantly more frequent in non-acral melanoma than acral melanoma. In conclusion, lymphatic invasion was more common in acral melanoma than non-acral melanoma and occurred in acral melanoma cases with relatively thin Breslow thickness, suggesting acral melanoma is lymphotropic.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Gong HZ, Zhang S, Zheng HY, Qu T, Li J. The role of mechanical stress in the formation of plantar melanoma: a retrospective analysis of 72 chinese patients with plantar melanomas and a meta‐analysis. J Eur Acad Dermatol Venereol 2019; 34:90-96. [PMID: 31494985 DOI: 10.1111/jdv.15933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
Affiliation(s)
- H Z Gong
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - H Y Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T Qu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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