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Melanoma

E326: Factors Associated with Recurrence Risk and Survival in Patients with Acral Melanoma

Introduction: Acral melanomas are rare and understudied forms of melanomas. The goal of this study is to evaluate histopathologic and genomic data in parallel using NGS panel data in patients with acral melanoma to correlate to clinical outcomes.

Methods: We performed a single-center retrospective study based on data from a 15-year (2009-2023) cohort of melanoma patients. Patients with acral melanoma were included, and their demographic and tumor data were collected. Genomic analysis of formalin-fixed, paraffin-embedded tissue samples was performed via an internal NGS platform (SNaPshot).  Clinical outcome rates were compared with Chi-square test, and univariate and multivariable Cox Regressions, with the level of significance set at 95% (p=0.05).

Results: A total of 49 patients with a median age of 69 years were included, with a male/female ratio of 1.1/1. At first diagnosis 45% of patients presented with stage I or II, 53% with stage III, and 2% with stage IV disease. The median time to recurrence from surgical excision was 18 months and Recurrence-Free Survival was significantly shorter with a higher Breslow subgroup, an absence of Tumor-Infiltrating Lymphocytes, a higher mitotic rate and the existence of APC mutation. Median Overall Survival from initial diagnosis was 31 months, and it was significantly shorter with a higher number of lymph node metastases at initial diagnosis. A total of 37% of patients progressed to stage IV disease and 83% of those received systemic therapy. The regimens involved BRAF/MEK inhibitors, immunotherapy, or novel regimens tested in trials. Median Progression-Free Survival and Overall Survival from systemic treatment start were 3.5 months and 14 months respectively.

Conclusions: In our study, traditional histopathologic factors, as well as genetic mutations displayed a significant correlation with disease recurrence and patient survival. The integration of NGS panel assay data allows insight into the biology of acral melanomas, facilitating further research into novel therapeutics.

Learning Objectives:

  • Upon completion, participants will be able to define the histopathological and genetic characteristics that influence the recurrence risk and overall survival of acral melanomas.
  • Upon completion, participants will be able to understand the value of PCR assay in order to illuminate genetic prognostic and predicting factors for acral melanoma progression.
  • Upon completion, participants will be able to understand the progression of acral melanomas, basic differences with cutaneous melanomas, and the differences in their treatment response and how these are influenced.