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Huang BL, Tan M, Li ML, Teng YY, Zhou M, Wang M. Case report: Type 2 diabetes mellitus with plantar malignant melanoma: Report of two cases. Front Oncol 2023; 13:1089578. [PMID: 36937447 PMCID: PMC10022727 DOI: 10.3389/fonc.2023.1089578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Malignant melanoma is a highly malignant tumor that originates from melanocytes. It has a poor prognosis and rarely occurs on the foot. Diabetic foot ulcer is one of the most serious chronic complications of diabetes. This paper reports two cases of type 2 diabetes patients with malignant melanoma on the foot. Clinicians should improve their understanding of patients with diabetes with acral malignant melanoma. When diabetic foot ulcers occur repeatedly and continue not to heal, the clinical features of the cutaneous lesions are similar to malignant melanoma, and a pathological biopsy of the lesions should be performed promptly to obtain a clear diagnosis, avoid a missed diagnosis and improve the survival rate.
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Affiliation(s)
- Bi-Ling Huang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Tan
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming-Liu Li
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuan-Yuan Teng
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Zhou
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Wang
- Department of Endocrinology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Min Wang,
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Lee TL, Lin MH, Liao YH, Liau JY, Sheen YS. Clinicopathological characteristics and prognosis in significantly thick acral lentiginous melanoma in Taiwan. J Formos Med Assoc 2022; 121:2338-2344. [PMID: 34961669 DOI: 10.1016/j.jfma.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/23/2022] Open
Abstract
This retrospective cohort study enrolled 385 patients diagnosed with cutaneous melanoma from 1980 to 2021 in National Taiwan University Hospital (NTUH). The aim of this study was to investigate the relationship between thickness of primary melanoma lesions and disease outcome of melanoma patients, in particular, those diagnosed with acral lentiginous melanoma (ALM). The association between important clinicopathological characteristics other than tumor thickness and disease outcome was also analyzed. Survival analyses with the Kaplan-Meier method were utilized to investigate the prognoses of patients with different lesion thickness. The male-to-female ratio was 1.12:1. The median age at diagnosis was 63 years old (mean: 62.2 years). There were 283 cases (73.5%) of acral lentiginous melanoma (ALM) with a male-to-female ratio of 1.04:1. Between patients with primary ALM lesions 4.1 millimeters (mm) to 8.0 mm thick and those with lesions over 8.0 mm thick, significant differences in prognostic outcomes including incidence of second recurrences within 1 year (raw p = 0.003, Bonferroni corrected p = 0.009) and distant metastases within 1 year (raw p = 0.003, Bonferroni corrected p = 0.008), were observed. Significantly worse 1-year (raw p = 0.01, Bonferroni corrected p=0.03) and 2-year survival (raw p = 0.006, Bonferroni corrected p = 0.02) were found in ALM patients with lesions of over 8 mm thick than those with lesions 4.1 mm to 8.0 mm at diagnosis. Vigilant short-term follow-up is warranted in ALM patients with lesions of over 8.0 mm thick at diagnosis due to higher risks of adverse outcome.
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Affiliation(s)
- Tung-Lin Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jau-Yu Liau
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Woo SJ, Kang J, Hu JL, Kwon ST, Chang H, Kim BJ. Medial Plantar Fasciocutaneous Flap Reconstruction for Load-Bearing Foot Defects in Patients With Acral Melanoma. Ann Plast Surg 2022; 88:658-664. [PMID: 35180757 DOI: 10.1097/sap.0000000000003091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is a rare subtype of malignant melanoma that usually involves the weight-bearing plantar area. Plantar defect reconstruction has traditionally been performed with skin grafts or free flaps. This study examined the efficacy and safety of a medial plantar artery perforator flap (MPAPF) for plantar defect reconstruction after wide excision of an ALM. METHOD Twenty-five patients who underwent reconstruction with a MPAPF between 2011 and 2021 were enrolled in this study. The defects were classified into 6 plantar zones. Demographic and clinical data were retrospectively analyzed. RESULTS Reconstruction with medial plantar fasciocutaneous island flaps was performed in all cases, except for 4 patients who had lesions in forefoot, which required free medial plantar flaps. Defects in lateral and posterior heel were more likely to present with venous congestion and require longer healing times and revision surgery (P < 0.05). The average follow-up period was 49 months. Four and 5 patients developed local recurrence and distant metastasis, respectively. Four cases of hyperkeratosis and paresthesia were documented, but there were no cases of ulceration or wound dehiscence. None of the cases required secondary debulking procedures. CONCLUSIONS The MPAPF is safe and effective for plantar defect reconstruction among patients with ALM. Meticulous dissection and adequate tunneling are needed, particularly for defects in the lateral and posterior heel, to minimize flap congestion and revision operations.
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Affiliation(s)
- Soo Jin Woo
- From the Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Arango Abisaad J, Arciniegas Grisales V, Londoño García Á, Vasquez Trespalacios E, Jiménez Calfat G, Cuello López J. [Translated article] Characteristics of Acral Lentiginous Melanoma According to Location in Stress- or Non–Stress-Bearing Areas: A Retrospective Study of 95 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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5
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Características del melanoma lentiginoso acral según su relación con la presión. Estudio retrospectivo de 95 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:134-140. [DOI: 10.1016/j.ad.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
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Arango Abisaad J, Arciniegas Grisales V, Londoño García Á, Vasquez Trespalacios E, Jiménez Calfat G, Cuello López J. Characteristics of Acral Lentiginous Melanoma According to Location in Stress- or Non–Stress-Bearing Areas: A Retrospective Study of 95 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee TL, Liao YH, Liau JY, Sheen YS. Risk factors of recurrence and distant metastasis in primary cutaneous melanoma in Taiwan. Sci Rep 2021; 11:21012. [PMID: 34697327 PMCID: PMC8545938 DOI: 10.1038/s41598-021-00386-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Risk factors of recurrence and distant metastasis of acral lentiginous melanoma (ALM) are of great interest for the high percentage of ALM in cutaneous melanoma in Asian populations. This single-center retrospective cohort including 177 patients with localized melanoma diagnosed from 2004 to 2020 aims to identify adverse predictors in cutaneous melanoma in Taiwan, with a focus on ALM. The relationship between clinicopathological features and outcomes, including incidences of recurrence and distant metastasis in 5 years from diagnosis, was analyzed. This study included 124 patients (70.1%) with ALM and 53 (29.9%) with non-ALM melanoma. Regarding clinicopathological characteristics, ALM patients were diagnosed at an older age and received sentinel lymph node biopsies (SLNBs) more often, while adjacent melanocytic nevi were more prevalent in non-ALM patients. With respect to prognostic implications of clinicopathological features, in ALM, implementation of SLNB was associated with a lower 5-year distant metastasis rate. Thickness of melanoma lesions over 4 mm, ulceration, and neurotropism, were related to both higher 5-year recurrence and distant metastasis rates. With regard to non-ALM patients, diagnoses made at or over 65 years old was linked to a higher 5-year recurrence rate, whereas ulceration was associated with both higher 5-year recurrence and distant metastasis rates. In conclusion, several clinicopathological characteristics have been identified to be associated with poor prognosis of cutaneous melanoma, especially ALM.
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Affiliation(s)
- Tung-Lin Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan S. Rd., Taipei, 100, Taiwan
| | - Jau-Yu Liau
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan S. Rd., Taipei, 100, Taiwan.
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8
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Abstract
Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal surface, and subungual area, in decreasing frequency. Diagnosis of melanoma of the hand and foot can be difficult because the traditional "ABCDE" (asymmetric shape, border, color, diameter, evolution) rules do not apply. Newer acronyms have been proposed in literature including "CUBED" (colored, uncertain, bleeding, enlarged, delayed) and "ABC rule for Subungual Melanoma." Once diagnosed, treatment is primarily surgical excision and reconstruction. The goal for the surgeon is to maintain the function and anatomy of the hand or foot.
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Park HS, Kim JH, Cho MY, Chung KY, Roh MR. PTEN Promoter Hypermethylation Is Associated with Breslow Thickness in Acral Melanoma on the Heel, Forefoot, and Hallux. Ann Dermatol 2020; 33:18-25. [PMID: 33911808 PMCID: PMC7875221 DOI: 10.5021/ad.2021.33.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 11/08/2022] Open
Abstract
Background Acral melanoma occurs on glabrous skin or the nail apparatus and is distinct from ultraviolet-related melanoma due to differing genetic alteration patterns. Although the pathogenesis of acral melanoma is not well understood, mechanical stress is thought to induce acral melanoma. The incidence of gene mutation and promoter methylation has been reported in tumors from acral melanoma; however, an association between genetic/epigenetic alterations and mechanical stress in acral melanoma remains unclear. Objective To investigate the relationship between clinical/genetic factors and mechanical stress in acral melanoma. Methods A retrospective review of 52 patients diagnosed with acral melanoma was performed. We reviewed the clinical characteristics of patients, tumor status, and tumor location. Mutations in BRAF, NRAS, and the TERT promoter, along with KIT amplification and PTEN promoter methylation were analyzed in the tumors. Results The heel (34/52, 65.4%) was the most common anatomical tumor site. Mutations in BRAF (6/48, 12.5%), NRAS (6/49, 12.2%), and the TERT promoter (4/33, 12.1%), along with KIT amplification (3/37, 8.1%) and PTEN promoter hypermethylation (12/48, 25.0%) were observed in the tumors. On the forefoot, heel, and hallux, PTEN promoter hypermethylation was significantly associated with Breslow thickness (p=0.001) and ulceration rate (p=0.042). On the midfoot and lesser toes, there was no significant difference in Breslow thickness or ulceration rate regardless of PTEN promoter hypermethylation (p>0.05). Conclusion PTEN promoter hypermethylation is associated with Breslow thickness and tumor ulceration on the forefoot, heel, and hallux in acral melanoma in Korean patients.
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Affiliation(s)
- Hae Seok Park
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hoon Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Yeon Cho
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Dika E, Veronesi G, Altimari A, Riefolo M, Ravaioli GM, Piraccini BM, Lambertini M, Campione E, Gruppioni E, Fiorentino M, Melotti B, Ferracin M, Patrizi A. BRAF, KIT, and NRAS Mutations of Acral Melanoma in White Patients. Am J Clin Pathol 2020; 153:664-671. [PMID: 32017841 DOI: 10.1093/ajcp/aqz209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Malignant acral melanoma (AM) is relatively infrequent in white patients. Molecular investigations have returned variable results regarding the mutational pattern. We sought to describe the mutation profile and clinicopathologic features of AM. METHODS We investigated BRAF, KIT, and NRAS mutational status in a series of 31 AM samples from white patients. RESULTS Nodular melanoma was the most common histopathologic subtype (48.4%), followed by acral lentiginous melanoma (25.8%) and superficial spreading melanoma (25.8%). BRAF, KIT, and NRAS mutational rates were 12.9%, 17.2%, and 30.0%, respectively. We observed significant associations between KIT mutational status and a thinner Breslow thickness compared with wild-type (WT) status (P = .002), NRAS mutation status and younger age compared with WT. In patients presenting at least one mutation, triple-WT patients presented metastases most frequently. CONCLUSIONS Although these data represent preliminary results, better knowledge of tumor biology and prognosis of AM can support the clinical approach and follow-up.
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Affiliation(s)
- Emi Dika
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Giulia Veronesi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Annalisa Altimari
- Laboratory of Oncologic and Transplantation Molecular Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Mattia Riefolo
- Laboratory of Oncologic and Transplantation Molecular Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Giulia Maria Ravaioli
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Martina Lambertini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Elena Campione
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisa Gruppioni
- Laboratory of Oncologic and Transplantation Molecular Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Michelangelo Fiorentino
- Laboratory of Oncologic and Transplantation Molecular Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Barbara Melotti
- Medical Oncology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Manuela Ferracin
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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11
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Translational pathology, genomics and the development of systemic therapies for acral melanoma. Semin Cancer Biol 2019; 61:149-157. [PMID: 31689494 DOI: 10.1016/j.semcancer.2019.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022]
Abstract
Acral melanomas arise on the non-hair bearing skin of the palms, soles and in the nail beds. These rare tumors comprise 2-3 % of all melanomas, are not linked to UV-exposure, and represent the most frequent subtype of melanomas in patients of Asian, African and Hispanic origin. Although recent work has revealed candidate molecular events that underlie acral melanoma development, this knowledge is not yet been translated into efficacious local, regional, or systemic therapies. In the current review, we describe the clinical characteristics of acral melanoma and outline the genetic basis of acral melanoma development. Further discussion is given to the current status of systemic therapy for acral melanoma with a focus on ongoing developments in both immunotherapy and targeted therapy for the treatment of advanced disease.
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12
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Bose A, Petsko GA, Eliezer D. Parkinson's Disease and Melanoma: Co-Occurrence and Mechanisms. JOURNAL OF PARKINSONS DISEASE 2019; 8:385-398. [PMID: 29991141 PMCID: PMC6130416 DOI: 10.3233/jpd-171263] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that is characterized by loss of dopaminergic neurons in the substantia nigra pars compacta, depletion of dopamine in the striatum and the presence of Lewy bodies. Cancer is uncontrolled growth of cells in the body and migration of these cells from their site of origin to other parts of the body. PD and cancer are two opposite diseases, one arising from cell proliferation and the other from cell degeneration. This fundamental difference is consistent with inverse comorbidity between most cancers and neurodegenerative diseases. However, a positive association of PD and melanoma has been reported which has recently become of significant interest. A link between PD and cancer has been supported by many epidemiological studies, most of which show that PD patients have a lower risk of developing most cancers than the general population. However, the mechanisms underlying this epidemiological observation are not known. In this review we focus on epidemiological studies correlating PD and melanoma and the possible mechanisms underlying the co-occurrence of the two diseases. We explore possible explanations for the important observations that more PD patients develop melanoma that would otherwise be expected and vice-versa.
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Affiliation(s)
- Anindita Bose
- Helen and Robert Appel Alzheimer's disease Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Gregory A Petsko
- Helen and Robert Appel Alzheimer's disease Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - David Eliezer
- Department of Biochemistry, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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13
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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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Cho SI, Lee J, Jo G, Kim SW, Minn KW, Hong KY, Jo SJ, Cho KH, Kim BJ, Mun JH. Local recurrence and metastasis in patients with malignant melanomas after surgery: A single-center analysis of 202 patients in South Korea. PLoS One 2019; 14:e0213475. [PMID: 30845184 PMCID: PMC6405088 DOI: 10.1371/journal.pone.0213475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 11/22/2022] Open
Abstract
Malignant melanoma (MM) is a lethal skin cancer in Western countries. Although the incidence is low in Asians compared to that in Caucasians, it is increasing. However, literature regarding risk factors for prognosis of MM patients who have undergone surgical excision in Asian is limited. This study aimed to investigate the predictive factors for local recurrence and metastasis in MM patients who underwent surgical treatment at a single tertiary-level hospital in Korea. Patients who underwent surgery for MM at our institution between January 1998 and December 2014 were analyzed. We retrospectively investigated risk factors for local recurrence and metastasis after surgery. In cases with distant metastasis, tumor thickness (adjusted Hazard Ratio (HR), 6.139; 95% confidence interval (CI), 2.152 to 17.509; P = 0.001) and increased mitotic number [(0-1/mm2 vs 2-6/mm2: adjusted HR, 4.483; 95% CI, 1.233 to 16.303; P = 0.023); (0-1/mm2 vs > 6/mm2: adjusted HR, 10.316; 95% CI, 2.871 to 37.063; P < 0.001)] were associated with risk in multivariate analysis. Regarding local recurrence, tumor thickness (T4 [≥4mm] vs T1) was found to be a significant risk factor (adjusted HR, 8.461; 95% CI, 2.514 to 28.474; P = 0.001). Our data revealed tumor thickness and increased mitotic count were significant risk factors for local recurrence and distant metastasis in Korean patients with MM after surgery.
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Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaewon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gwanghyun Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Won Minn
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang Hyun Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (JHM); (BJK)
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (JHM); (BJK)
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15
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Ravaioli GM, Dika E, Lambertini M, Chessa MA, Fanti PA, Patrizi A. Acral melanoma: correlating the clinical presentation to the mutational status. GIORN ITAL DERMAT V 2018. [PMID: 29512974 DOI: 10.23736/s0392-0488.18.05791-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Acral lentiginous melanoma (ALM) is the most common type of malignant melanoma (MM) in Asians, Afro-Americans and Middle-Easterners. It represents 1.5-10% of all MM cases, being the most common histological type of MM arising on palms, soles and nail apparatus, which is more generically defined as acral MM. To date no risk factors have been officially established, however a history of trauma may be involved in the pathogenesis of acral MM. This shows heterogeneous clinical features and frequently presents with advanced stage and aggressive behavior, often as a result of misdiagnosis or delayed identification. Dermoscopy is helpful for an early diagnosis of ALM: the most characteristic dermoscopic patterns are the parallel ridge and the irregular diffuse pigmentation. On histopathology ALM displays a lentiginous growth pattern, with melanocytes arranged as solitary units along the basilar epidermis, without notable pagetoid growth in the early stage. Not all acral MMs present a lentiginous pattern: superficial spreading melanoma and nodular melanoma patterns are also possible. Novel studies investigating the biologic characteristics of acral MM reported variable results: the overall mutational rates ranged respectively between 8.5% and 23% for KIT, between 3.6% and 33.3% for BRAF and between 3% and 47% for NRAS in ALMs. Increasing attention has been recently given to other genes, such as telomerase reverse transcriptase, platelet-derived growth factor receptor alfa and cyclin D1. Larger molecular investigations urge to describe the molecular profile of acral MM, to allow the development of specific targeted therapies.
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Affiliation(s)
- Giulia M Ravaioli
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Emi Dika
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Martina Lambertini
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco A Chessa
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Pier Alessandro Fanti
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Section of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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A clinicopathological analysis of 153 acral melanomas and the relevance of mechanical stress. Sci Rep 2017; 7:5564. [PMID: 28717212 PMCID: PMC5514126 DOI: 10.1038/s41598-017-05809-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
The pathogenesis of melanomas emerging in plantar surfaces remains unclear; however, mechanical stress has been reported to increase the formation of melanomas. In this study, we conducted a multicenter retrospective analysis of 153 acral melanomas diagnosed between 2000 and 2015 in Taiwan. The male-to-female ratio of the patients in question was 1:1.28, and the mean age at diagnosis was 68 years. We examined whether melanomas which developed in different areas of the patients' soles differed in their associations with various clinicopathological characteristics and survival. Testing by goodness of fit indicated that stress-bearing areas were significantly more conducive to the generation of melanomas than non-stress-bearing areas (P < 0.0001). More specifically, compared to the arch, the rear of the foot and front of the foot were significantly more conducive to the generation of melanomas (P < 0.0001 and P < 0.0001, respectively). The distribution pattern was not associated with differences in age, gender, right/left foot involvement, ulceration, mitosis, lymph node metastasis, tumor thickness, or stage. The overall, distant metastasis-free, and recurrence-free survival rates did not differ significantly between the stress-bearing and non-stress-bearing areas. Furthermore, while acral melanomas tended to develop on stress-bearing areas, the distribution pattern was not associated with the prognostic index or survival.
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17
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Gao W, Chen D, Ran X. Malignant melanoma misdiagnosed as diabetic foot ulcer: A case report. Medicine (Baltimore) 2017; 96:e7541. [PMID: 28723771 PMCID: PMC5521911 DOI: 10.1097/md.0000000000007541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Acral lentiginous melanoma (AML) does not exhibit the classic signs of malignant melanoma. ALM is frequently misdiagnosed because of its unusual sites and atypical clinical morphologies, which lead to poor prognosis. PATIENT CONCERNS A female patient aged 78 years was presented to our center with two ulcers on her right foot. Diabetic foot ulcer was considered as the primary diagnosis. The ulcers failed to improve after 2 weeks' therapy. DIAGNOSES An incisional biopsy of the lesion revealed malignant melanoma. INTERVENTIONS The patient received wide excision, skin grafting as well as biotherapy. OUTCOMES The lesion was healed and no other metastasis has been founded until now. LESSONS Clinicians must maintain a high level of suspicion in distinguishing malignant melanoma from other more benign skin lesions of the foot. The need for early biopsy of ulcer, even when clinical suspicion is low, can not be overemphasized. Only in this way can we reduce misdiagnosis rate and improve survival rate in patients with foot ulcer.
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Affiliation(s)
- Wei Gao
- Department of Endocrinology and Metabolism
- Health Management Center
| | - Dawei Chen
- Department of Endocrinology and Metabolism
- Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism
- Diabetic Foot Care Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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18
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Malignant melanoma of sun-protected sites: a review of clinical, histological, and molecular features. J Transl Med 2017; 97:630-635. [PMID: 28092366 DOI: 10.1038/labinvest.2016.147] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/22/2016] [Accepted: 12/06/2016] [Indexed: 01/16/2023] Open
Abstract
In most cases of cutaneous melanoma, ultraviolet (UV) radiation is recognized as a prominent risk factor. Less is known regarding the mechanisms of mutagenesis for melanoma arising in sun-protected sites, such as acral and mucosal melanoma. Acral and mucosal melanoma share many common features, including a late age of onset, a broad radial growth phase with prominent lentiginous growth, the presence of field cancerization cells, and, in most cases, lack of a precursor nevus. In addition to early chromosomal instability, many of the same genes are also involved in these two distinct melanoma subtypes. To better understand non-UV-mediated pathogenesis in melanoma, we conducted a joint literature review of clinical, histological, and molecular features in acral and mucosal melanoma. We also reviewed the current literature regarding aberrations in KIT, PDGFRA, TERT, and other commonly involved genes. By comparing common features of these two subtypes, we suggest potential mechanisms underlying acral and/or mucosal melanoma and offer direction for future investigations.
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Sue GR, Hanlon A, Lazova R, Narayan D. Use of imiquimod for residual acral melanoma. BMJ Case Rep 2014; 2014:bcr2014203826. [PMID: 25188932 PMCID: PMC4154021 DOI: 10.1136/bcr-2014-203826] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/03/2022] Open
Abstract
Recent reports suggest that topical imiquimod cream is an effective treatment option for certain types of melanomas. No reports exist on the efficacy of using imiquimod cream to treat melanoma located on the plantar surface of the foot. We present two patients with a melanoma of the foot who had residual melanoma following surgical excision with acceptable margins. The patients were then treated with topical imiquimod for 8 weeks after which a repeat biopsy of the affected region showed no evidence of residual melanoma in situ. The use of topical imiquimod cream should be considered in the management of residual melanoma in situ of the plantar surface of the foot.
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Affiliation(s)
- Gloria R Sue
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Allison Hanlon
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rossitza Lazova
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Deepak Narayan
- Section of Plastic Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Lacruz G, Cárdenas I, Carrera C, Díaz A, Puig-Butillè JA, Badenas C, Malvehy J, Puig S. Multiple Primary Acral Melanomas in Two Young Caucasian Patients. Dermatology 2014; 228:307-10. [DOI: 10.1159/000362207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 03/15/2014] [Indexed: 11/19/2022] Open
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21
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Yin NC, Miteva M, Covington DS, Romanelli P, Stojadinovic O. The Importance of Wound Biopsy in the Accurate Diagnosis of Acral Malignant Melanoma Presenting as a Foot Ulcer. INT J LOW EXTR WOUND 2013; 12:289-92. [DOI: 10.1177/1534734613512505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neoplastic changes arising at the sites of chronic, nonhealing wounds are not uncommon; however, they often go undiagnosed. We report a case of rapidly progressing plantar melanoma presenting as a chronic, nonhealing ulcer. A 46-year-old patient presented at a specialized Wound Healing Center with an enlarging painful ulcer on the right heel of 3 months duration. The wound was biopsied and specimens were sent for examination at the Wound Pathology service at the Department of Dermatology and Cutaneous Surgery, University of Miami. Histology demonstrated features consistent with acral malignant melanoma. Immunohistochemistry using melanocytic markers MART-1, S-100, HMB-45 revealed positive staining indicating the presence of malignant cells, and D2-40 staining showed lymphatic invasion of the tumor in the wound biopsy specimen. The case presented here underscores the importance of wound biopsying in the diagnosis of malignancies associated with nonhealing wounds.
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Affiliation(s)
- Natalie C. Yin
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariya Miteva
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Paolo Romanelli
- University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Alexandrescu DT, Maslin B, Kauffman CL, Ichim TE, Dasanu CA. Malignant Melanoma in Pigmented Skin: Does the Current Interventional Model Fit a Different Clinical, Histologic, and Molecular Entity? Dermatol Surg 2013; 39:1291-303. [DOI: 10.1111/dsu.12251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Durbec F, Martin L, Derancourt C, Grange F. Melanoma of the hand and foot: epidemiological, prognostic and genetic features. A systematic review. Br J Dermatol 2012; 166:727-39. [DOI: 10.1111/j.1365-2133.2011.10772.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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24
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Pan T, Li X, Jankovic J. The association between Parkinson's disease and melanoma. Int J Cancer 2011; 128:2251-60. [PMID: 21207412 DOI: 10.1002/ijc.25912] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 12/20/2010] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a loss of melanin-positive, dopaminergic neurons in the substantia nigra. Although there is convincing epidemiologic evidence of a negative association between PD and most cancers, a notable exception to this is that melanoma, a malignant tumor of melanin-producing cells in skin, occurs with higher-than-expected frequency among subjects with PD and that melanoma patients are more likely to have PD. A clear biological explanation for this epidemiological observation is lacking. Here, we present a comprehensive review of published literature exploring the association between PD and melanoma. On the basis of published findings, we conclude that (i) changes in pigmentation including melanin synthesis and/or melanin synthesis enzymes, such as tyrosinase and tyrosine hydroxylase, play important roles in altered vulnerability for both PD and melanoma; (ii) changes of PD-related genes such as Parkin, LRRK2 and α-synuclein may increase the risk of melanoma; (iii) changes in some low-penetrance genes such as cytochrome p450 debrisoquine hydroxylase locus, glutathione S-transferase M1 and vitamin D receptor could increase the risk for both PD and melanoma and (iv) impaired autophagy in both PD and melanoma could also explain the association between PD and melanoma. Future studies are required to address whether altered pigmentation, PD- or melanoma-related gene changes and/or changes in autophagy function induce oncogenesis or apoptosis. From a clinical point of view, early diagnosis of melanoma in PD patients is critical and can be enhanced by periodic dermatological surveillance, including skin biopsies.
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Affiliation(s)
- Tianhong Pan
- Diana Helis Henry Medical Research Foundation, New Orleans, LA, USA
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25
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Bristow IR, de Berker DA. Development of a practical guide for the early recognition for malignant melanoma of the foot and nail unit. J Foot Ankle Res 2010; 3:22. [PMID: 20920168 PMCID: PMC2954980 DOI: 10.1186/1757-1146-3-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/28/2010] [Indexed: 01/09/2023] Open
Abstract
Background Malignant melanoma is a rare but potentially lethal form of cancer which may arise on the foot. Evidence suggests that due to misdiagnosis and later recognition, foot melanoma has a poorer prognosis than cutaneous melanoma elsewhere. Methods A panel of experts representing podiatry and dermatologists with a special interest in skin oncology was assembled to review the literature and clinical evidence to develop a clinical guide for the early recognition of plantar and nail unit melanoma. Results A systematic review of the literature revealed little high quality data to inform the guide. However a significant number of case reports and series were available for analysis. From these, the salient features were collated and summarised into the guide. Based on these features a new acronym "CUBED" for foot melanoma was drafted and incorporated in the guide. Conclusions The use of this guide may help clinicians in their assessment of suspicious lesions on the foot (including the nail unit). Earlier detection of suspicious pedal lesions may facilitate earlier referral for expert assessment and definitive diagnosis. The guide is currently being field tested amongst practitioners.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
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26
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Baumert J, Schmidt M, Kunte C, Volkenandt M, Ruzicka T, Berking C, Schmid-Wendtner MH. Plantar melanoma: is the prognosis always bad? Dermatol Surg 2010; 36:1325-7. [PMID: 20584045 DOI: 10.1111/j.1524-4725.2010.01632.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jens Baumert
- Department of Dermatology and Allergology, Ludwig Maximilian University Munich, Munich, Germany
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27
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Rogers LC, Armstrong DG, Boulton AJM, Freemont AJ, Malik RA. Malignant melanoma misdiagnosed as a diabetic foot ulcer. Diabetes Care 2007; 30:444-5. [PMID: 17259529 DOI: 10.2337/dc06-2251] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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28
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Multiple Primary Acral Melanomas in African-Americans. Dermatol Surg 2007. [DOI: 10.1097/00042728-200701000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Hutcheson ACS, McGowan JW, Maize JC, Cook J. Multiple Primary Acral Melanomas in African-Americans: A Case Series and Review of the Literature. Dermatol Surg 2007; 33:1-10. [PMID: 17214672 DOI: 10.1111/j.1524-4725.2007.33000.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer-related deaths. We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs). OBJECTIVE The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM. METHODS This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005. A thorough review of the literature was performed. RESULTS Four patients, all African-American, were identified with multiple ALM. All patients were managed with excision or Mohs micrographic surgery utilizing permanent sections. None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer. Several had acral melanosis. Information in the literature on patients with multiple primary acral melanomas was insufficient. CONCLUSION Patients with multiple acral melanomas have not, to our knowledge, been reported thus far. It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any.
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Affiliation(s)
- Angela C S Hutcheson
- Department of Dermatology, Medical University of South Carolina, Chareston, South Carolina 29425, USA
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30
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Dalmau J, Abellaneda C, Puig S, Zaballos P, Malvehy J. Acral melanoma simulating warts: dermoscopic clues to prevent missing a melanoma. Dermatol Surg 2006; 32:1072-8. [PMID: 16918571 DOI: 10.1111/j.1524-4725.2006.32232.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acral melanoma may adopt a variety of clinical characteristics simulating other tumors, ulcers, hemorrhage, or infections. In the Caucasian population health care providers often misdiagnose acral melanoma, and this is the cause of inadequate treatments. Clinical and dermoscopic clues can be easily recognized, which help to prevent missing a melanoma. OBJECTIVES To study the clinical and dermoscopic findings in three cases of acral melanoma simulating warts that had been treated by dermatologists with curettage and cryotherapy. MATERIAL AND METHODS Clinical and dermoscopic study of the tumors and review of the most frequent simulators of acral melanoma reported in the literature. RESULTS In all three tumors, hyperkeratosis and the lack of specific pigmentation were observed. The parallel ridge pattern, revealed by dermoscopic examination, precipitated the recognition of acral melanoma. CONCLUSION In these cases that presented atypical characteristics of acral lesions, therefore challenging the diagnostic process, dermoscopic examination helped to confirm an accurate diagnosis of acral melanoma.
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Affiliation(s)
- Joan Dalmau
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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31
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Gray RJ, Pockaj BA, Vega ML, Connolly SM, DiCaudo DJ, Kile TA, Buchel EW. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705. [PMID: 17038281 DOI: 10.1177/107110070602700908] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis. We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot. METHODS A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004. The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence. RESULTS The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%). The average time to diagnosis was 17 months. Initial clinical diagnosis had been considered benign in 12 (32%). The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%. Thirteen patients (34%) had ulcerated lesions. Sentinel lymph node biopsy specimens of 25 patients identified four (16%) with metastatic disease. Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction. Systemic recurrence developed in six patients, four of whom also had regional recurrence. CONCLUSIONS Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas. Reconstructive surgical procedures had a high rate of complications; however, overall functional outcomes were good. Stage of cancer at diagnosis was associated with systemic metastases.
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Affiliation(s)
- Richard J Gray
- Division of General Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA
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32
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Acral Melanoma Simulating Warts. Dermatol Surg 2006. [DOI: 10.1097/00042728-200608000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The incidence of acral lentiginous melanoma (ALM) varies in different ethnic groups. Volar skin is a relatively infrequent site of malignant melanoma in Caucasian patients, although the foot is the most common site of involvement in Asian and African populations. Diagnosis of ALM is usually delayed and melanomas can be diagnosed at advanced clinical stages, so the prognosis is often poor. We present a Caucasian Turkish man with ALM on the interdigital site of his foot, however, as a result of maceration of the surrounding skin, it seemed to be tinea pedis.
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Affiliation(s)
- Gamze Serarslan
- University of Mustafa Kemal Faculty of Medicine, Department of Dermatology, Atatürk Street, 97/1, 31034 Antakya, Turkey.
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34
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Abstract
Malignant melanoma is increasing at a rate faster than any other cancer in the United States. Location of the primary tumor on the foot is associated with poorer prognosis. This study evaluates a cohort of 148 patients with melanoma of the lower extremity (37 foot or ankle and 111 leg, knee, or thigh) diagnosed at a university medical center during a 32-year period. The mean follow-up for the foot/ankle patients was 44 months. The overall 5-year survival rate was 52% for patients with a primary melanoma of the foot/ankle compared with 84% for patients with a primary melanoma elsewhere on the lower extremity. Although the study period extended over 32 years, nearly 65% of the foot/ankle patients were diagnosed in the last decade. This increase is most likely because of the documented increase in incidence of melanoma in the United States and an increasing referral pattern at our institution.
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Affiliation(s)
- Susan M Walsh
- Department of Orthopedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA.
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35
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Soon SL, Solomon AR, Papadopoulos D, Murray DR, McAlpine B, Washington CV. Acral lentiginous melanoma mimicking benign disease: the Emory experience. J Am Acad Dermatol 2003; 48:183-8. [PMID: 12582386 DOI: 10.1067/mjd.2003.63] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Plantar and subungual melanoma exhibits a higher misdiagnosis rate relative to other anatomic sites. Misdiagnosis and delay in diagnosis are statistically associated with poorer patient outcome. Awareness of atypical presentations of acral melanoma may, thus, be important to decrease misdiagnosis rates and improve patient outcome. METHODS We conducted a retrospective case review of plantar or lower-extremity subungual melanoma performed at Winship Cancer Center, a tertiary care, referral center affiliated with Emory University, between 1985 and 2001. RESULTS A total of 53 cases of plantar or lower-extremity subungual melanoma were identified. Of 53 cases with a final diagnosis of melanoma, 18 were initially misdiagnosed. Misdiagnoses included wart, callous, fungal disorder, foreign body, crusty lesion, sweat gland condition, blister, nonhealing wound, mole, keratoacanthoma, subungual hematoma, onychomycosis, ingrown toenail, and defective/infected toenail. Of the 18 misdiagnosed cases, 9 were clinically amelanotic. CONCLUSION Awareness that amelanotic variants of acral melanoma may assume the morphology of benign hyperkeratotic dermatoses may increase the rate of correct diagnosis and improve patient outcome.
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Affiliation(s)
- Seaver L Soon
- Department of Dermatology, Emory University School of Medicine, 5001 Woodruff Memorial Building, Atlanta, GA 30322, USA
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Abstract
Melanoma is a significant health problem. Despite public education and free cancer screenings, the incidence and mortality of melanoma continues to rise; however, many currently diagnosed melanomas are thin lesions, suggesting that education and awareness is having an impact. In addition, there are still subsets of patients who need increased surveillance in order to increase their survival. Although large congenital nevi may be precursors of melanoma, small and medium congenital nevi have an insignificant risk for melanoma development. Large congenital nevi, which are axial in location, appear to be more likely to develop melanoma and are associated with melanocytosis and melanoma of the CNS, both of which portend a poor prognosis. Recently, the recommended margins of excision have become more conservative so that many of the surgical defects can be closed primarily. Lymphoscintigraphy and sentinel node biopsy have replaced elective node dissections, thus decreasing the morbidity associated with the surgical management of melanoma. Although controversy still exists as to whether or not sentinel lymph node biopsy alters a patient's prognosis, it has been shown to be a powerful prognostic indicator. Although most melanomas are managed by routine surgical excision, other modalities are sometimes employed. For example, cryosurgery or radiation therapy may be indicated in the frail, elderly individual with a large facial lentigo maligna. Mohs surgery is the treatment of choice for head and neck melanomas and those located in areas where maximum preservation of tissue is required and for desmoplastic and acral lentiginous melanomas. Much more work remains in the area of adjuvant therapy, chemotherapy, and immunotherapy. Dacarbazine remains the drug of choice in disseminated melanoma, but remissions are usually short lived. Interleukin and biochemotherapy has yielded good results but the percentage benefiting is small. Although high dose interferon increases disease-free and overall survival in some patients, it remains a controversial drug which is not easily tolerated. In the new staging system for melanoma, ulceration is second only to Breslow's thickness. In transit (satellite) lesions have also been included in this new system. The new system also recognizes that patients with only microscopic metastatic nodal disease fare better than patients with clinically enlarged metastatic nodes and that it is the number of nodes involved with metastases, not their size, that determines the patient's prognosis. Except for lesions <1mm thick, the Clark's level of invasion has been de-emphasized.
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Affiliation(s)
- Pearon G Lang
- Medical University of South Carolina, Charleston, South Carolina 29925, USA
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37
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Franke W, Neumann NJ, Ruzicka T, Schulte KW. Plantar malignant melanoma -- a challenge for early recognition. Melanoma Res 2000; 10:571-6. [PMID: 11198479 DOI: 10.1097/00008390-200012000-00009] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of malignant melanoma has been continuously increasing over the last few decades. Non-plantar melanomas are nowadays usually diagnosed and treated surgically at an early stage. In contrast, melanoma in a plantar location is usually diagnosed at an advanced tumour stage, conferring a poor prognosis. To discover the reasons for this remarkable difference in recognition and prognosis, we analysed our cases of plantar malignant melanoma in a retrospective study. From 1990 to 1997, we treated 925 melanoma patients. Of these, 68 cases (7%) were classified as plantar melanoma. For non-plantar melanoma patients the mean age was 52.6 years, the mean Clark level was 2.8 and the mean tumour depth was 1.22 mm. In contrast, the mean age of patients with plantar melanoma was 63.3 years, the mean Clark level was 3.61 and the mean tumour depth was 2.55 mm. The mean time between the first observation of the plantar skin lesion and the first consultation with a physician (patients' delay) was 4.8 years and, on average, it took an additional 7 months before adequate surgical treatment was performed (physicians' delay). The prognosis of our patients was poor. In 98.5% (n = 67) further metastases were observed on follow-up. Since there is still no cure for advanced plantar malignant melanoma, the early detection and subsequent surgical treatment of plantar melanoma is decisive for the prognosis. Based on our results, the poor survival can be improved by a significant reduction in the time period between the first observation of a plantar skin lesion and surgical treatment. Therefore there is an urgent need for special preventive health care campaigns to reduce significantly both the patients' and the physicians' delay.
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Affiliation(s)
- W Franke
- Department of Dermatology, Heinrich-Heine University, Düsseldorf, Germany.
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39
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Kato T, Suetake T, Tabata N, Takahashi K, Tagami H. Epidemiology and prognosis of plantar melanoma in 62 Japanese patients over a 28-year period. Int J Dermatol 1999; 38:515-9. [PMID: 10440280 DOI: 10.1046/j.1365-4362.1999.00736.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The plantar surface is one of the commonest sites of malignant melanoma in the Japanese; however, the biological behavior is not sufficiently clarified, because of the paucity of long-term studies. We attempted an epidemiologic survey of the cases of plantar melanoma treated in our institute to study the survival rate in the recent period. METHODS Of the 207 cases of malignant melanoma observed over the past 28 years, 62 patients were diagnosed as having plantar melanoma. The proportion of plantar melanoma to all melanomas, the sex and age of the patients, and the histologic type, stage, and prognosis were evaluated by comparing those registered in the first half (1969-1982) and the second half (1983-1996) of the period. RESULTS The proportions of plantar melanoma in the first and second half periods were 31% (28 out of 90) and 29% (34 out of 117), respectively. No sex difference in the patients was observed. The mean age of the patients was 67 years. Fifty-one lesions were histologically proven to be acral lentiginous melanoma (ALM), two were superficial spreading melanoma (SSM), and nine were nodular melanoma (NM). Of the nine NMs, eight were registered in the second half period. The heel was affected in 33 (53%), the metatarsal regions in nine (14%), the toes in six (10%), and the arch areas in 14 (23%). The proportion of the weight-bearing areas, including the heel, metatarsal areas, and toes, decreased in the second half period. A comparison of the stages of plantar melanoma showed that, in the first half period, there were 18% of patients with stage IV disease in contrast to none in the second half period. Conversely, the proportion of stage I and II disease was 50% in the second half period, whereas it was only 39% in the first half period. The 5-year survival rates in the first and second half periods were 56% and 71%, respectively. CONCLUSIONS The prognosis of plantar melanoma has improved recently at our institute. The possible explanation for a trend to better survival in the second half period may be related to a decrease in stage IV disease as well as to an increase in the frequency of diagnosis of early stage disease.
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Affiliation(s)
- T Kato
- Department of Dermatology, Tohoku University School of Medicine, Tohoku Koseinenkin General Hospital, Sendai, Japan
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Talley LI, Soong S, Harrison RA, McCarthy WH, Urist MM, Balch CM. Clinical outcomes of localized melanoma of the foot: a case-control study. J Clin Epidemiol 1998; 51:853-7. [PMID: 9762878 DOI: 10.1016/s0895-4356(98)00071-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The controversy over whether melanoma of the foot has a poorer prognosis than melanoma of the leg remains unresolved. This investigation used a case-control design to address this issue. This design consisted of a survival analysis of 119 cases with localized melanoma of the foot and 238 controls with localized melanoma of the leg that were matched on prognostic factors including tumor thickness, ulceration, surgical treatment, gender, year of diagnosis, and age. There was a statistically significant difference between the survival rates of cases and controls. The 5-year survival rate for cases was 74.3% compared to 85.2% for controls. At 10 years, the survival rate was 63.6% for cases and 77.2% for controls. Cases experienced a higher percentage of distant recurrences than controls. These results imply that patients with melanoma of the foot have a poorer survival than patients with melanoma of the leg after controlling for prognostic factors.
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Affiliation(s)
- L I Talley
- Biostatistics Unit, University of Alabama at Birmingham, USA
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Cho KH, Han KH, Minn KW. Superficial spreading melanoma arising in a longstanding melanocytic nevus on the sole. J Dermatol 1998; 25:337-40. [PMID: 9640889 DOI: 10.1111/j.1346-8138.1998.tb02408.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Asians, the plantar surface is the commonest site for cutaneous melanoma, and most melanomas arising in this region are the acral lentiginous type. Herein we describe a rare case of superficial spreading melanoma arising in a longstanding melanocytic nevus on the sole of a Korean.
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Affiliation(s)
- K H Cho
- Department of Dermatology, Seoul National University College of Medicine, Korea
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Abstract
The authors present a case report of acral lentiginous malignant melanoma in a 77-year-old male. Melanoma is a rare but increasingly present malignant lesion of the lower extremity. It is the most common malignant neoplasm in blacks and is often misdiagnosed. Early, accurate diagnosis and biopsy of suspicious lesions is the cornerstone of treatment in order to decrease possible future morbidity and mortality. The authors discuss the clinical features, differential, diagnosis, predisposing factors, diagnosis, classification, and treatment of malignant melanoma.
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Affiliation(s)
- B Lemon
- Department of Podiatric Surgery, Kern Hospital, Warren, Michigan, USA
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Hudson DA, Fenn C, Krige JE, Johnson C. Melanoma of the foot in white South Africans. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1996; 30:315-9. [PMID: 8976027 DOI: 10.3109/02844319609056410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There have been few studies that have compared the outcome of treatment of melanoma on the sole and dorsum of the foot or defined their prognostic factors. We describe 44 white patients (30 women and 14 men, mean age 53 years) with melanoma on the foot (sole, n = 25, dorsum, n = 19) seen over a 15 year period. Forty patients presented with stage I, two with stage II, one with stage III, and one with stage IV disease. The median Breslow depth of penetration was 2.8 mm (sole 3.3, dorsum 2.3). Of the 40 patients with stage I disease, 34 patients (17 dorsum, 17 sole) were treated by wide local excision (2 cm or more) and none developed local recurrence. Six patients (five sole, one dorsum) who had narrow excision margins (less than 1 cm, stage I disease) developed local recurrences. Ten patients underwent prophylactic hyperthermic limb perfusion. Sixteen patients with stage I disease (10 sole, six dorsum) developed metastases in the inguinal nodes. All 16 underwent block dissection of the nodes and five are alive. The overall survival for both dorsum (73%) and sole (66%) (stage I disease) was similar at 60 months. Both patients with stage II disease were alive at the time of writing, but the two patients with stage III and IV disease had died. The foot is an anatomical subsite associated with a poor prognosis for melanoma. There is little difference in prognostic factors and outcome between the sole and dorsum.
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Affiliation(s)
- D A Hudson
- Department of Plastic and Reconstructive Surgery, University of Cape Town, South Africa
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