Abstract
Acral lentiginous melanoma (ALM) is a subtype of melanoma that primarily affects ethnic minorities and is associated with poor outcomes. Racial inequalities in melanoma survival, particularly between Blacks and Whites, have been well documented in the literature. There are limited data on the role of surgical approach to ALM and its contribution to the existing disparities in ALM survival. Thus, this study aimed to investigate the role of surgical approach to ALM among Mohs surgeons. The survey was distributed to members of the American College of Mohs Surgery (ACMS), with 43 physicians completing the survey. The results showed that there was no consensus among Mohs surgeons regarding the surgical approach for ALM, even for advanced stages. 74% respondents performed complete circumferential peripheral and deep margin assessment (CCPDMA) for ALM, including Mohs micrographic surgery (MMS) or en face staged excision. However, barriers such as limited training, low comfort operating on acral sites, and inadequate access to specialized biopsies were reported. Treatment recommendations varied widely regardless of the ALM stage, with no significant differences based on exposure to ALM during training, practice setting, or percent of skin of color patients served. These findings highlight the lack of guidelines and the need for more data on outcomes to support optimal management of ALM. The study emphasizes the importance of addressing healthcare disparities and improving survival outcomes, particularly for ethnic minorities affected by ALM. Consensus guidelines could help standardize treatment approaches and potentially reduce disparities in ALM management.
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Kolla AM, Vitiello GA, Friedman EB, Sun J, Potdar A, Daou H, Farrow NE, Farley CR, Vetto JT, Han D, Tariq M (2021) Acral lentiginous melanoma: a United States multi-center substage survival analysis. Cancer Control 7:28. https://doi.org/10.1177/10732748211053567
Yan BY, Barilla S, Strunk A, Garg A (2022) Survival differences in acral lentiginous melanoma according to socioeconomic status and race. J Am Acad Dermatol 86(2):379–386. https://doi.org/10.1016/j.jaad.2021.07.049
Zhang J, Yun SJ, McMurray SL, Miller CJ (2021) Management of nail unit melanoma. Dermatol Clin 39(2):269–280. https://doi.org/10.1016/j.det.2020.12.006
Terushkin V, Brodland DG, Sharon DJ, Zitelli JA (2016) Digit-sparing Mohs surgery for melanoma. Dermatol Surg 42(1):83–93. https://doi.org/10.1097/dss.0000000000000587
Hanson J, Demer A, Liszewski W, Foman N, Maher I (2020) Improved overall survival of melanoma of the head and neck treated with Mohs micrographic surgery versus wide local excision. J Am Acad Dermatol 82(1):149–155. https://doi.org/10.1016/j.jaad.2019.08.059
Lino-Silva LS, Zepeda-Najar C, Salcedo-Hernández RA, Martínez-Said H (2019) Acral lentiginous melanoma: survival analysis of 715 cases. J Cutan Med Surg 23(1):38–43. https://doi.org/10.1177/10732748211053567
Asgari MM, Shen L, Sokil MM, Yeh I, Jorgenson E (2017) Prognostic factors and survival in acral lentiginous melanoma. Br J Dermatol 177(2):428–435. https://doi.org/10.1111/bjd.15600
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NI, AD, and ML. All authors contributed to manuscript preparation and final manuscript.
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Isaq, N.A., Demer, A.M., Vidal, N.Y. et al. Dermatologic surgeons’ approaches to acral lentiginous melanoma: a survey of the American College of Mohs Surgery. Arch Dermatol Res 316, 17 (2024). https://doi.org/10.1007/s00403-023-02744-w
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DOI: https://doi.org/10.1007/s00403-023-02744-w