Barrera JA, Herrera GNE, Fernández RF, Mercadillo PP

Language: Spanish
References: 12
Page: 166-171
PDF size: 171.17 Kb.

ABSTRACT

Malignant melanoma is a highly metastatic neoplasia. Early diagnosis is vital. The most commonly reported subtypes in our country are nodular and acral lentiginous melanoma, however, there are very few reports about these clinical presentations. The aim of this study is to describe and compare the clinical and histopathological variables between the nodular subtype and acral lentiginous in Mexican patients. This was an observational, descriptive and retrospective study performed at the Dermatopathology Service of Hospital General de México Dr. Eduardo Liceaga. We collected data of clinical (age, sex, topography, morphology and evolution) and histopathological variables (Breslow, Clark level, mitotic rate, ulceration, necrosis and lymphovascular invasion). For the statistical analysis, Xi2 and Fisher exact tests were used, as well as the estimation of or and Student t test.
Eighty-three cases were identified: 47 (56.6%) of nodular melanoma and 36 (43.3%) of acral lentiginous melanoma. Sex distribution was similar (36.1 and 34% of women in both nodular and acral lentiginous subtype, respectively), an average age of 65.7 years (SD 14.4) for the acral variant and 65.3 years (sd 14.5) for the nodular variant. Eight patients had a lesion affected the foot with an 8.8 times higher risk of acral lentiginous subtype or, nodular morphology was 33 times at a greater risk of being nodular variant and macular presentation was strongly associated (OR = 27.9) with the acral lentiginous subtype.
For histological variables, only three patients of acral lentiginous melanoma (8.3%) were detected in situ, and due to the high histological thickness (› than 4 mm), or the presence of ulceration and necrosis, most nodular melanomas (37 cases, 78.7%) had a Breslow not measurable. Breslow average was 0.95 mm (SD 0.64) for acral lentiginous melanoma and 2.59 mm (SD 0.88) for nodular melanoma. We also identified that the nodular variant carried a risk of histological ulceration (OR) of 5.9 times higher and a mitotic rate average of 2.73 per highpower field (SD 1.34) which was higher than in the acral lentiginous subtype, but without statistical difference. We concluded that nodular melanoma is the most common subtype in our population. Both variants have similar gender and age distribution. Foot location and macular morphology are most frequently associated to the acral lentiginous variant, while nodular morphology and histological ulcerations are most frequently correlated to the nodular subtype. The vast majority of cases in Mexico are diagnosed at an advanced stage of the disease with a very poor prognosis.

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