A Clinicopathologic Analysis of 177 Acral Melanomas in Koreans Relevance of Spreading Pattern and Physical Stress
A Clinicopathologic Analysis of 177 Acral Melanomas in Koreans Relevance of Spreading Pattern and Physical Stress
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DOI：
10.1001/jamadermatol.2013.5853
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发表时间：
2013-11-01
期刊：
影响因子：
10.9
通讯作者：
Yun, Sook Jung
中科院分区：
文献类型：
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作者：
Jung, Ho Joo;Kweon, Sun-Seog;Yun, Sook Jung
重要性 尽管创伤可能是一个诱发因素，但肢端黑色素瘤的发病机制仍不清楚。通过详细的解剖图研究长期身体压力与发病率和扩散模式之间的关系，对于了解肢端黑色素瘤的独特特征可能很重要。 目的 分析肢端黑色素瘤的流行病学和临床病理学特征，并根据不同部位（体重或非负重部分）的发病率和预后差异分析，评估长期身体压力或压力强度如何影响肢端黑色素瘤。 设计、背景和患者 对 1994 年 1 月 1 日至 2012 年 10 月 31 日期间 177 名韩国肢端黑色素瘤患者进行横断面回顾性研究。主要结果和措施肢端黑色素瘤的解剖图和组织病理学检查。结果男女比例为1:1.03，以及平均年龄 首次入院时年龄为55.3岁。肢端雀斑样黑色素瘤是最常见的组织病理学亚型（85.9%），其次是结节性黑色素瘤（12.8%）。在身体压力较大的部位，例如脚后跟中心和前脚内侧，肢端黑色素瘤的发病率很高。此外，经常观察到黑色素瘤长轴的特殊扩散模式，通常沿着由于脚底长期受压而自然产生的折痕。预后指数和生存率显示，掌侧和甲下位置之间或足底的负重部分和非负重部分之间没有显着差异。结论和相关性在韩国人和其他亚洲人之间，晚期诊断并导致低生存率的肢端黑色素瘤的临床病理特征没有显着差异。有趣的是，根据我们的研究，长期的身体压力或压力强度可以以特定的方式影响肢端黑色素瘤的发病率和扩散模式。肢端黑色素瘤发生在身体压力较大的部位，长轴沿着脚底的自然折痕。为了更好地了解肢端黑色素瘤的病理生理学特征，需要进一步的前瞻性研究，特别是原位病变，关于发病率、进展和生存的位置差异。
Importance The pathogenesis of acral melanoma remains unclear, even though trauma may be a predisposing factor. A study about the association of long-term physical stress with the incidence and spreading patterns through detailed anatomic mapping may be important to understand the unique features of acral melanoma.Objectives To analyze the epidemiologic and clinicopathologic characteristics of acral melanoma and evaluate how long-term physical stress or pressure strength influences acral melanoma based on the analysis of differences in incidence, prognosis of the distinct site (weight or nonweight-bearing portion of sole, volar, or subungual location), and the spreading pattern of melanoma on the soles.Design, Setting, and Patients Cross-sectional, retrospective study of 177 Korean patients with acral melanoma from January 1, 1994, through October 31, 2012.Main Outcomes and Measures Anatomic mapping and histopathologic examination of acral melanoma.Results The male to female ratio was 1:1.03, and the mean age at first admission was 55.3 years. Acral lentiginous melanoma was the most common histopathologic subtype (85.9%), followed by nodular melanoma (12.8%). There was a high incidence of acral melanoma at more physically stressed sites, such as the center of the heels and inner forefoot. In addition, a peculiar spreading pattern with the long axis of melanoma, typically along naturally occurring creases due to long-term pressure on the soles, was often observed. The prognostic index and survival rate showed no significant difference between volar and subungual locations or between weight and nonweight-bearing portions of the soles.Conclusions and Relevance Clinicopathologic characteristics of acral melanoma diagnosed at an advanced stage and resulting in a low survival rate are not significantly different between Koreans and other Asians. Interestingly, based on our study, long-term physical stress or pressure strength can influence the incidence and spreading pattern of acral melanoma in a particular manner. Acral melanoma occurs on more physically stressed sites with the long axis along natural creases on the sole. A further prospective investigation, especially of in situ lesions, regarding location-based differences in incidence, progress, and survival is necessary to better understand the pathophysiologic characteristics of acral melanoma.