Metastatic acral lentiginous melanoma in a tertiary referral center in Switzerland: a systematic analysis
Abstract
Acral lentiginous melanoma (ALM) is a unique histopathological subtype of melanoma with a poorer prognosis than other cutaneous melanomas. This study aims to evaluate the clinicopathological characteristics, metastatic pattern, prognostic factors, response to systemic therapy, and overall survival (OS) of ALM in a White population.
This is a retrospective study of patients who were diagnosed and/or treated for ALM at the Department of Dermatology of the University Hospital Zurich, witzerland, from January 2005 to December 2015. Overall, 72 patients with histologically confirmed ALM were ncluded in the study.
In univariate Cox regression, Breslow hickness (P<0.001), age (P=0.003), status of sentinel ymph node (P=0.005), and ulceration (P=0.008) were dentified as significant prognostic factors for OS in ALM. In ultivariate analysis, only Breslow thickness (P=0.0003) howed statistical significance.
The median OS (mOS) was 55.7 months in the entire cohort (n=172) and 11.2 months or stage IV patients (n=36), irrespective of treatment. hen first treatment was considered (n=35), mOS for tage IV patients was 8.9, 16.6, 21.7, and 3.7 months, for patients who had received chemotherapy (ChT) (n=17), mmunotherapy (n=9), targeted therapy (TT) (n=3), and no herapy (n=6), respectively. The overall response rate was 4% (7/16 patients) to ChT, 100% to TT (3/3), and 25% to ipilimumab (2/8).
In our study, Breslow thickness epresents the best prognostic factor for OS. In stage IV LM patients treated with either immunotherapy or TT, there is a trend for extended mOS compared with ChT.