Occupational epidemiology of acral lentiginous melanoma

Acral lentiginous melanoma (ALM) classically presents in glabrous skin. Some studies suggest an association between mechanical stress and ALM development. People working jobs with long periods of standing/walking may be exposed to near-daily mechanical stress. To investigate the relationship between occupation type and ALM development, we performed a retrospective cohort study using Optum's Clinformatics Database (2007-2023). We compared the risk of ALM in adults with occupational data (n = 9,270,935). Retired patients had the highest prevalence (0.081) and incidence per 1,000,000 person-years (0.514, 95% confidence interval = 0.487-0.542) of ALM. We performed multivariate logistic regression, adjusted for demographics and insurance, and stratified by age. In patient aged <65 years, homemaker patients had 55.2% increased risk of ALM (P < .001). In patients aged ≥65 years, retired patients had 17% increased risk of ALM (P < .001). Our findings suggest that homemaker and retired patients are at highest risk of ALM, possibly owing to increased mechanical stress on the palmoplantar surfaces associated with work around the home in homemakers. Occupation-related mechanical stress may play a role in the retired population as well, although the previous occupation of retired patients is unreported. Future directions include exploring prior occupations in the retired population.