A global perspective on prognosis in acral and nonacral cutaneous melanoma: A systematic review and meta-analysis

Acral melanoma (AM) is a rare cutaneous malignancy associated with poor survival. However, prognostic differences between AM and nonacral cutaneous melanoma (NAM) remain unclear. Therefore, we conducted a systematic review and meta-analysis to compare survival outcomes between patients with AM and those with NAM.

PubMed, EMBASE, and the Cochrane Library were comprehensively searched for studies published between January 2000 and December 2025. Studies comparing the 5-year overall survival (OS) and 5-year relapse-free survival (RFS) between AM and NAM were included. Subgroup analyses were performed by disease stage and ethnicity to assess their impact on melanoma prognosis.

Twenty studies (18 retrospective and two prospective cohort studies) involving 568 346 patients were included. The meta-analysis demonstrated that AM was associated with significantly lower 5-year OS than NAM (risk ratio [RR]: 0.89; 95% CI: 0.86-0.92; p < 0.00001). In subgroup analyses, compared with NAM, AM was associated with poorer 5-year OS in both stage II (RR: 0.92; 95% CI: 0.88-0.96; p = 0.0003) and stage III disease (RR: 0.85; 95% CI: 0.75-0.96; p = 0.01). Additionally, patients from darker-skinned populations with AM had poorer 5-year OS than those from White populations (RR: 0.89; 95% CI: 0.83-0.95; p = 0.0006).

Patients with AM exhibited markedly lower 5-year OS than those with NAM, particularly among patients with stage II and III. Moreover, individuals from darker-skinned populations with AM had poorer survival outcomes than those from White populations.