Limb melanomas: acral melanomas have worse survival

The anatomic site of primary melanoma is significantly correlated with survival, and extremity melanomas have better prognosis than trunk or head and neck melanomas.

The aim of this study was to review and evaluate the prognostic factors and survival outcomes associated with both upper and lower extremity melanomas.

A total of 524 limb-located melanomas were analyzed retrospectively.

Lower extremity melanomas were predominant in number and feet/toes melanomas were more frequently found in the elderly. Acral lentiginous melanomas were found to affect more frequently lower limbs and showed mainly distal distributions for both limbs. However, acral melanomas were more often ulcerated and they were more frequently BRAF wild-type melanomas associated with significant lymphovascular invasion. Foot and toe melanomas relapsed more frequently than leg melanomas. The 5-year overall survival rates for upper and lower limbs were the same, 62%. The finger (p = .0001) and toe (p = .005) melanomas had worse overall survivals than arm and leg melanomas, respectively. Both overall and disease-free survivals of acral melanoma patients were found worse than those of nonacral melanoma patients, p = .0001 and p = .001 respectively. Despite not having adjusted by Breslow, ulceration and nodal involvement status, acral location per se could be associated with poorer outcome in our retrospective study.

Even though they were not found to be correlated with major predictors of poor prognosis, acral melanomas significantly predict poor survival.