Clinicopathologic analysis of malignant melanoma in Taiwan,☆☆

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Abstract

Background: Malignant melanoma is the leading cause of death among skin cancers in western countries. However, the incidence, histologic subtypes, and tumor behaviors are quite different in Asians and people of color. Objective: Our purpose was to define the tumor behaviors and possible prognostic predictors of melanomas based on a Taiwanese patient population. Methods: From the 65 patients diagnosed with melanoma at Veterans General Hospital, Taichung, we analyzed mean age at onset, gender, histologic subtypes, tumor thickness, level of invasion, primary tumor locations, and metastatic sites. Univariate analysis and multivariate analyses for survival, according to clinical and histologic tumor behaviors, were performed by means of Cox proportional hazard model. Survival curves were plotted by Kaplan-Meier method. Results: Fifty-one cutaneous melanomas were identified and analyzed by both clinical behaviors and histology. Acral lentiginous melanoma was the most common type (54.9%), followed by nodular melanoma (29.4%), superficial spreading melanoma, and lentigo maligna melanoma. Univariate analysis for overall survival of melanoma revealed that age at onset older than 55 years, male gender, ulceration of tumor, and thicker tumor have the tendency to poorer prognosis, but without significant differences. The advanced stages (III and IV) and histologic subtypes other than acral lentiginous melanoma predicted a poorer survival with significant differences. Multivariate analysis demonstrated advanced stages, and histologic subtypes were the independent risk factors for poor prognosis. Conclusion: We proposed that histologic subtypes other than acral lentiginous melanoma and advanced stages have a poorer prognosis with significant differences. (J Am Acad Dermatol 1999;41:945-9.)

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PATIENTS AND METHODS

From Nov 1, 1985 to June 30, 1998, 65 patients were diagnosed with malignant melanoma at Veterans General Hospital, Taichung. From these 65, we excluded 12 patients with mucosal melanoma, and 2 patients with cutaneous melanoma whose pathologic specimens were not available for evaluation.

We reviewed the medical records of the remaining 51 cases of cutaneous malignant melanoma, including age, sex, primary location of tumor, stages, metastatic locations, and survival status. The histologic

Age, sex, and subtype distributions

A total of 51 patients with melanoma were analyzed in this study. Acral lentiginous melanoma (ALM) was the most common subtype (28/51, 54.9%), followed by nodular melanoma (NM) (15/51, 29.4%), superficial spreading melanoma (4/51, 7.8%), and lentigo maligna melanoma (4/51, 7.87%) (Table I). The mean ages of the patients in each subtype were 65 years, 56 years, 65 years, and 58 years, respectively. Patients with ALM and superficial spreading melanoma tended to have later onset. More male

DISCUSSION

ALM is quite rare and comprises only 3% to 10% of melanomas in western countries.16 It is, however, the predominant form of melanoma affecting Asians, African-Americans, and other individuals of color.16 It accounts for about 35% to 50% of all melanomas in Japan and Taiwan.8, 9, 10, 11, 12, 13 Because of their secluded body locations, ALMs are not usually recognized until the late stages, when they are ulcerated or large in size, so they tend to have a poor prognosis.17 However, when corrected

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    Reprint requests: Jui-Lung Shen, MD, Department of Dermatology, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung-Kang Road, Taichung, Taiwan, R.O.C.

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