Clinicopathologic and survival differences between upper and lower extremity melanomas.

Area of Science:

• Oncology
• Dermatology
• Surgical Pathology

Background:

• Melanoma of the extremities requires comparative analysis for treatment optimization.
• Sentinel lymph node (SLN) biopsy is a critical staging tool for extremity melanomas.
• Understanding prognostic factors based on tumor location is essential for patient management.

Purpose of the Study:

• To compare clinicopathologic factors, SLN status, and survival outcomes between upper extremity (UE) and lower extremity (LE) melanoma patients.
• To identify specific risk factors associated with LE melanomas.
• To evaluate the impact of tumor location on melanoma recurrence and survival.

Main Methods:

• Post hoc analysis of a prospective clinical trial involving 1115 patients with extremity melanomas (Breslow thickness ≥ 1.0 mm).
• Evaluation of survival using Kaplan-Meier analysis.
• Univariate and multivariate analyses were performed to assess risk factors.

Main Results:

• Lower extremity (LE) melanoma patients were younger, predominantly female, and had a higher rate of SLN metastasis compared to UE patients.
• LE melanomas showed worse 5-year disease-free survival (DFS) and local/in-transit recurrence-free survival, but no difference in overall survival (OS).
• Older patients (>51 years) with LE melanomas had worse DFS, recurrence-free survival, and OS.

Conclusions:

• Patients with LE melanomas face a greater risk of positive SLN and local/in-transit recurrence than those with UE melanomas.
• While LE tumor location is not an independent risk factor for OS or DFS, specific subgroups like older patients exhibit poorer outcomes.
• These findings highlight the importance of considering tumor location in the management and prognostic assessment of extremity melanomas.