Acral Lentiginous Melanoma Often Presents As Advanced Disease in Minority Patients

Mature woman with painful hand.
Racial and ethnic differences in the clinical presentation and outcomes in patients with acral lentiginous melanoma ALM were investigated.

Patients with acral lentiginous melanoma (ALM) who are Black, Hispanic, and Asian generally present with more advanced lesions that are more ulcerated and thicker compared with patients who are non-Hispanic White, suggesting early diagnosis of this disease is a key challenge in minority populations. This is according to study research published in the British Journal of Dermatology.

The findings from this study were based on an analysis of patients with histologically confirmed ALM who were registered in the US National Cancer Database (NCDB) from 2004 to 2016 (n=4139). Researchers conducted several statistical analyses to examine associations of patient characteristics with survival outcomes.

Overall, the median age of the population at time of ALM diagnosis was 64 years. A significantly greater percentage of Black, Asian, and Hispanic patients had lower-extremity lesions compared with White patients (90% vs 85% vs 87% vs 80%, respectively; P <.001). In addition, patients who were Black and Asian presented with lesions with the highest median Breslow thickness (1.65 and 1.77 mm, respectively) compared with those who were Hispanic and White (1.5 and 1.50 mm, respectively; P =.001).

At presentation, ulceration was more common in patients who were Black (47%), Asian (42%), and Hispanic (45%) compared with White patients (36%; P <.001). A greater percentage of patients who were Black and “other” were treated with radiation (4% and 4%, respectively) compared with those who were White, Asian, and Hispanic (2% vs 2% vs 2%, respectively; P =.031).

Patients who were White had a higher median overall survival (OS) time (11.3 years) and greater 5-year OS (67.6%) compared with Hispanic (median OS: 10.7 years; 5-year OS: 66.8%), Asian (median OS: 9.2 years; 5-year OS: 67.1%), “other” (median OS: 6.9 years; 5-year OS: 68.4%), and Black (median OS: 6.4 years; 5-year OS: 59.3%) patients.

A limitation of the study included the reliance on potential erroneous data in the NCDB, which the investigators allow could have resulted in the inclusion of patients with other subtypes of cutaneous melanomas that were misclassified as ALM.

The researchers concluded that their findings emphasize “earlier diagnosis and better access to care can help improve the racial and ethnic disparities seen in ALM.”


Behbahani S, Malerba S, Samie FH. Racial and ethnic differences in the clinical presentation and outcomes of acral lentiginous melanoma. Published online July 19, 2020. Br J Dermatol. doi:10.1111/bjd.19406