Acral (volar-subungual) melanoma in Auckland, New Zealand

We have retrospectively reviewed the charts of 34 acral melanoma patients (melanoma arising from the volar skin of the hands, feet or a subungual site) seen in the Auckland area between 1970 and 1985. These 34 patients constituted 3.5 per cent of the total number of patients (972) reviewed over this period. Six of the thirty-four patients were either Polynesian or Maori. There were 19 men and 15 women, and the mean age of the group was 59 years. The primary lesion arose from the plantar or palmar skin in 25 patients and 9 patients had subungual lesions. All lesions but one were pigmented. Most patients with plantar or palmar lesions presented with clinical stage 1, Clark's level 4 disease, while those with subungual lesions presented most commonly with stage 2, Clark's level 5 disease. Treatment was wide local resection for plantar and palmar lesions and amputation for subungual lesions. Regional lymph node dissection was performed in 10 patients with positive nodes at presentation and in 6 patients who developed metachronous nodal disease. Patients were followed for between 1 and 16 years, and 18 patients died in this period, 15 of metastatic melanoma (mean time 34 months). Subungual melanoma carried a worse prognosis than melanoma arising in palmar or plantar skin.