ReportsAcral lentiginous melanoma mimicking benign disease: The Emory experience☆,☆☆,★,★★
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Methods
Cases of plantar and lower-extremity subungual melanoma were retrieved from the tumor registry of the Winship Cancer Center for the time period 1985 to 2001, inclusive. The Winship Cancer Center is a tertiary care, referral center affiliated with Emory University School of Medicine. The center subsumes the Emory Melanoma and Pigmented Lesions Center, which provides specialized, multidisciplinary care for patients with melanoma from the standpoints of medical oncology, surgical oncology,
Results
A total of 53 cases of plantar or lower-extremity subungual melanoma were identified during the study period. Of 53 cases with a final diagnosis of melanoma, 18 received a prior clinical diagnosis other than melanoma (Table I).
Patient No. Age (y) Sex Race Tumor site Initial diagnosis Breslow thickness at diagnosis (mm) Outcome 1 75 F Caucasian Left sole Callus 2.94 Alive; NED 2 79 F Caucasian Right sole Nonhealing ulcer 6.00 DOD 3 63 F Caucasian Right sole Crusty lesion 1.50 Alive; NED 4 62 M
Discussion
Misdiagnosis and delay in diagnosis are relevant topics in the discussion of a cancer that is eminently curable by conservative operation in its early stages, but associated with extremely poor outcome in advanced states. One retrospective study of 83 patients with acral melanoma reported a 36% clinical misdiagnosis rate3 with increased median tumor thickness (5 vs 1.5 mm), more advanced stage at diagnosis (stage IIIb and IV; 30% vs 5.6%), and lower estimated 5-year survival (15.4% vs 68.9%)
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Funding sources: None.
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Conflict of interest: None identified.
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Reprint requests: Carl V. Washington, MD, Emory University School of Medicine, Department of Dermatology, 5001 Woodruff Memorial Bldg, Atlanta, GA 30322. E-mail: [email protected].
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