| Background and objective:Malignant melanoma(MM)is an malignant tumor originating from the spinal melanocytes.Its incidence has been significantly increasing in most countries in recent decades.Acral melanoma(AM),a peculiar subgroup of melanoma occurring on the palms,soles,and nails,is the main subtype of melanoma in people of color and is extremely rare in Caucasians.Although great progress has been made in melanoma treatment in recent years,patients with AM have shown limited benefit from current therapies and thus consequently have worse overall survival rates.Widespread studies have been published in Western countries,and AM has been reported in many parts of Asia,including China.However,the large sample size retrospective analysis of AM in northern China is still very scarce and the epidemiology,clinicopathological characteristics,survival outcomes of AM are largely unknown.Therefore,more information about the clinicopathological features of AM in northern China is needed in order to better understand this highly aggressive and ethnically specific malignancy.Methods:The demographic characteristics,clinicopathological data,and prognostic data of patients diagnosed with AM by pathological examination of resected or biopsy specimens in 6hospitals in northern China from January 1,2003,to August 1,2022,were collected.SPSS27.0was used for statistical analysis to understand the epidemiological characteristics,clinicopathological characteristics,a nd factors affecting disease recurrence and survival of AM in 6 hospitals in northern China.Results:1.678 AM patients ranged in age from 21 to 86 years old,with an average age of 58 years old,a median age of 60 years old and a peak age of 60 to 69 years old.There were more females than males.Female AM patients are more common before 60 years old,while the incidence of male AM is higher than that of female AM after 60 years old.2.The primary sites of 656 cases were clear,including 119 cases(18.14%)under the nail,75 cases(11.43%)in the palm,and 462 cases(70.43%)in the foot.The sole of foot is the most common part of AM.3.The data of this study showed that stage 0-I,II,III and IV accounted for 19.6%,38.8%,28.9% and 12.6% respectively.The proportion of breslow thickness > 4mm was the highest(35.3%),while the proportion of breslow thickness ≤ 1mm was the lowest(15.8%).The most common sites of metastasis were lung(20.2%)and distant lymph nodes(20.5%).Ulcers were found in 296 cases(58.3%).4.In univariate analysis,a total of 11 factors were significantly correlated with 5-year survival rate: gender(P=0.014),tumor stage(P<0.001),ulcer(P=0.005),clark grade(P<0.001),Breslow thickness(P=0.030),mitotic image(P=0.036),satellite lesions(P=0.044),vascular invasion(P=0.007),traumatic stimulation(P<0.001),nevus correlation(P=0.004)and metastasis(P<0.001).Age(P=0.669)and primary site(P=0.935)were not statistically significant.5.By the end of follow-up,645 patients were included in the survival analysis after excluding patients with missing time of death.The overall 1-,3-,and 5-year OS rates were94.7%,81.0%,and 71.2%,respectively,and the median OS was not reached.6.Tumor stage,gender and clark grade were independent prognostic factors for DFS,while only tumor stage and ulcer were independent prognostic factors for OS.Conclusion:1.The peak incidence of AM is 60-69 years old.Patients in this age group should improve their awareness of self-screening and seek timely treatment.2.There are significant differences in the incidence between different parts of the foot,which is significantly higher than that of the palm and nail,similar to most countries.3.Compared with western countries,AM in northern China has thicker tumors,higher ulcer rate,later stage and worse prognosis.4.Tumor stage,gender and clark grade were independent prognostic factors for DFS,while only tumor stage and ulcer were independent prognostic factors for OS. |
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