Evaluation of surgical modalities for stage 0 to stage II acral lentiginous melanoma: A National Cancer Database study.

Abstract

e21590 Background: Wide Local Excision (WLE) is the standing surgical choice for Acral Lentiginous Melanoma (ALM), yet research is scarce in evaluating other surgical options for ALM and its recurrence rates remain two to five times more likely than other melanoma subtypes. This study evaluates the overall survival outcomes associated with different surgical modalities in patients with Stage 0-II ALM. Methods: This retrospective cohort study surveyed the National Cancer Database (NCDB) from 2004-2021 for ICD-10 codes specific for all skin structures with histologically confirmed ALM for Stage 0-II patients. Using IBM SPSS, statistical analyses were conducted via variable frequency with crosstabulations and Chi-squared tests, Kaplan Meier Survival Curves with Log-Rank Pairwise Comparisons, and Cox Proportional Hazards Regression Models. Results: Data for 6,737 patients showed significantly greater overall survival for Biopsy Followed by Gross Excision (BFGE) than WLE (mean overall survival = 155.773 months (p < 0.01); HR = 0.767 (95% CI, 0.677-0.87)). Mean overall survival for WLE was 151.554 (95% CI, 147.676 - 155.432). Cross analysis of Breslow Depth (BD) with Surgical Procedures revealed the majority (21.8%) of WLEs were completed for lesions with a BD of 0.1 to 5 mm followed by 16.8% for lesions greater than 3 cm (p < 0.001). Cross-analysis of Surgical Margins of the Primary Site with Surgical Procedures, showed no residual tumor in 92.1% of all BFGE patients, which is 3.7% and 3.3% less patients than Major Amputation and WLE. Conclusions: This study highlights significant differences across ALM surgery options, suggesting each modality has their own niche and BFGE should be investigated further. Kaplan meier survival times. Surgical Procedure Categories Mean Survival (Months) Standard Error 95% Confidence Interval Wide Local Excision 151.554 1.979 147.676 - 155.432 Mohs Surgery NS 137.212 6.687 124.105 - 150.319 Biopsy Followed by Gross Excision of Lesion ***155.773 2.836 150.214 - 161.332 Other Procedures *143.259 5.221 133.026 - 153.491 Major Amputation ***126.966 3.614 119.883 - 134.049 The first group, WLE, represents the reference group used for Log-Rank Test Pairwise Comparisons. *represents p value < 0.05; **represents p value < 0.01; ***represents p value < 0.001; and NS indicates no significance.