M M Asgari1,2, L Shen2, M M Sokil2, I Yeh3, E Jorgenson2. 1. Department of Dermatology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, U.S.A. 2. Division of Research, Kaiser Permanente Northern California, Oakland, CA, U.S.A. 3. Departments of Pathology and Dermatology, University of California at San Francisco, San Francisco, CA, U.S.A.
Abstract
BACKGROUND: Acral lentiginous melanoma (ALM) is a rare melanoma subtype that disproportionately afflicts people of colour. ALMs have a worse prognosis than other melanoma subtypes; this has been attributed to aggressive biological behaviour, more advanced stage at presentation and possible disparities in access to health care. OBJECTIVES: To examine, using comprehensive patient data and long-term follow-up information in a well-characterized cohort, how patient, tumour and clinical management variables impact overall and melanoma-specific survival. METHODS: We characterized a consecutive cohort of 123 ALMs diagnosed from 1987 to 2013 and analysed predictors of overall and melanoma-specific survival for their association with survival. RESULTS: Univariate hazard ratios and 95% confidence intervals using Cox regression models showed that increased Breslow depth, presence of ulceration, receipt of radiation, chemo- and vaccine therapy were associated with worse melanoma-specific survival. Notably, nonwhite race/ethnicity was not associated with worse overall or melanoma-specific survival. Multivariate modelling adjusting for patient, tumour and management variables revealed Breslow depth > 2 mm and disease extent as significantly associated with poor melanoma-specific survival. CONCLUSIONS: Melanoma-specific mortality among patients with ALM is associated with increased tumour thickness and more advanced stage at presentation, but not with race/ethnicity. Advanced tumour features at presentation and access to care may account for less favourable survival outcomes reported among nonwhite patients.
BACKGROUND:Acral lentiginous melanoma (ALM) is a rare melanoma subtype that disproportionately afflicts people of colour. ALMs have a worse prognosis than other melanoma subtypes; this has been attributed to aggressive biological behaviour, more advanced stage at presentation and possible disparities in access to health care. OBJECTIVES: To examine, using comprehensive patient data and long-term follow-up information in a well-characterized cohort, how patient, tumour and clinical management variables impact overall and melanoma-specific survival. METHODS: We characterized a consecutive cohort of 123 ALMs diagnosed from 1987 to 2013 and analysed predictors of overall and melanoma-specific survival for their association with survival. RESULTS: Univariate hazard ratios and 95% confidence intervals using Cox regression models showed that increased Breslow depth, presence of ulceration, receipt of radiation, chemo- and vaccine therapy were associated with worse melanoma-specific survival. Notably, nonwhite race/ethnicity was not associated with worse overall or melanoma-specific survival. Multivariate modelling adjusting for patient, tumour and management variables revealed Breslow depth > 2 mm and disease extent as significantly associated with poor melanoma-specific survival. CONCLUSIONS:Melanoma-specific mortality among patients with ALM is associated with increased tumour thickness and more advanced stage at presentation, but not with race/ethnicity. Advanced tumour features at presentation and access to care may account for less favourable survival outcomes reported among nonwhite patients.
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