Clinical features and prognosis of Asian patients with acral lentiginous melanoma who have nodal nevi in their sentinel lymph node biopsy specimen.

Nodal melanocytic nevi (NNs) encountered during sentinel lymph node biopsy (SLB) for malignant melanoma are usually difficult to distinguish from metastatic melanoma. However, NNs have not been well studied in acral lentiginous melanoma (ALM) in Asian populations. To investigate the clinical characteristics and significance of NNs in SLB specimens from patients with ALM. We retrospectively analyzed 84 patients with ALM who underwent SLB between June 2010 and July 2017. Of the 84 patients with ALM, 9 (10.7%) had NNs in their SLB specimens. NNs were significantly more common in SLB specimens than in specimens not obtained by SLB. The presence of pre-existing melanocytic lesions was found to be associated with NNs (P < .001). The 5-year overall survival was significantly higher in patients with ALM with NNs than in patients with a positive SLB result (P = .047). Distant recurrence in patients with ALM with NNs was significantly lower than in patients a positive SLB result (P = .03). The small sample size, single-center study design, and retrospective nature of the study were the limitations. In Asian populations, the prevalence of NNs in ALM is similar to that reported in Europe and the United States. The rates of distant recurrence and overall survival in patients with ALM who have NNs are similar to those of patients who do not have metastatic melanoma.

Kim HJ ，Seo JW ，Roh MS ，Lee JH ，Song KH ... -  《-》

Acral Lentiginous Melanoma Is Associated with Certain Poor Prognostic Histopathological Factors but May Not be Correlated with Nodal Involvement, Recurrence, and a Worse Survival.

Acral lentiginous melanoma (ALM) is a small subtype of melanoma affecting Caucasians far more often than other ethnic groups, such as blacks, Hispanics, and Asians. Only a few studies have yielded controversial results on ALM so far. The aim of this study was to define the histopathological and clinical expressions of ALM and to compare them with those of non-ALM in a large group of Turkish patients from a single referral institution. One hundred two ALM patients were analyzed retrospectively. The median age of the patients was 58 years. The lower limbs (the thigh and leg as well as the foot) were predominantly affected (78%) and cases were mostly nonungual (89%). ALM were found more frequently in females (p = 0.04). They were ulcerated (p = 0.0001), they were associated with neurotropism (p = 0.0001), they lacked the BRAF mutation (p = 0.03), and they less often coexisted with a preceding melanocytic nevus (p = 0.0001). No correlations were found between ALM and either nodal involvement or distant metastasis. The recurrence-free survival and overall survival rates for ALM patients were similar to those of patients with other histopathologies. The 5-year recurrence-free survival and 5-year overall survival rates for ALM patients were 58.7 and 59%, respectively. Although ALM is associated with some aggressive histopathological factors, it may not correlated with nodal involvement, recurrence, or poor survival.

Tas F ，Erturk K 《-》

Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005.

Bradford PT ，Goldstein AM ，McMaster ML ，Tucker MA ... -  《-》

Acral lentiginous melanoma: who benefits from sentinel lymph node biopsy?

There are significant clinicopathological, genetic, and biological differences between acral lentiginous melanoma (ALM) and other types of melanoma. We sought to investigate the use of sentinel lymph node (SLN) biopsy for patients with ALM. This was a retrospective review of 116 patients with primary ALM. Melanoma-specific and disease-free survival were estimated using the Kaplan-Meier method, together with multivariate analyses using the Cox proportional hazards regression model. All patients were Japanese (48 male and 68 female). Metastases in SLN were noted in 13 of 84 patients who underwent SLN biopsy. No patients with thin ALM (≤1 mm) and only 2 patients with nonulcerated ALM had tumor-positive SLN. Patients with positive SLN had significantly shorter melanoma-specific survival (5-year survival rate, 37.5% vs 84.3%; P < .0001) and disease-free survival (5-year survival, 37.5% vs 77.9%; P = .0024). Among patients with thick (>1 mm) ALM, the influence of SLN positivity on melanoma-specific survival was increased (5-year survival, 22.7% vs 80.8%; P = .0005). This was a retrospective study and had a small sample size. SLN biopsy should be considered for patients with thick or ulcerated ALM. For patients with thin or nonulcerated ones, it may be of limited importance.

Ito T ，Wada M ，Nagae K ，Nakano-Nakamura M ，Nakahara T ，Hagihara A ，Furue M ，Uchi H ... -  《-》

The "spaghetti technique": an alternative to Mohs surgery or staged surgery for problematic lentiginous melanoma (lentigo maligna and acral lentiginous melanoma).

Lentigo maligna (LM) and acral lentiginous melanoma (ALM) are often large and clinically ill defined. The surgical challenge is to spare tissue while still achieving clear margins. We sought to provide a retrospective assessment of a two-phase surgical technique for lentiginous melanomas (MM) not suitable for en bloc resection. In the first phase, a narrow band of skin, "the spaghetti", is resected just beyond the clinical outline of the MM, immediately sutured, and sent for pathological examination without removing the MM. The same procedure is repeated beyond the segments which are shown to be not tumor free and so forth until the minimal tumor-free perimeter is outlined. No operative wound is left between operative sessions. In the second phase, the MM resection and reconstruction are performed at the same time. In 21 patients with LM (n = 16) or ALM (n = 5), the mean operative defect size was 27.5 cm(2) (range, 1.97-108.4 cm(2)). The mean number of steps in the procedure was 1.55 (1-4). Grafts were used for reconstruction in all cases. The relevance of the "spaghetti"-defined outline was confirmed in 19 of 21 patients. After a median follow-up period of 25.36 months (range, 0-72 months), the local control rate was 95.24% with one case (4.76%) of in-transit invasive recurrence after 48 months. This study was performed at a single center and included a limited number of patients. The follow-up time was relatively brief. The "spaghetti technique" is simple and reliable for LM and ALM. Unlike Mohs surgery, it does not require specific training of surgeons or pathologists. Unlike staged surgery, it does not leave patients with an open wound on the face or soles before final reconstruction.

Gaudy-Marqueste C ，Perchenet AS ，Taséi AM ，Madjlessi N ，Magalon G ，Richard MA ，Grob JJ ... -  《-》