Depth of invasion analysis to predict acral melanoma outcomes

Acral melanoma is a subtype with worse outcomes. The Breslow micrometric measurement is the most critical parameter in planning treatment and predicting outcomes. However, for acral lentiginous melanoma, the value of the Breslow thickness is a matter of debate. Depth of Invasion (DOI) is a well-established measure for staging oral squamous cell carcinoma. This study compared DOI and Breslow thickness for predicting acral melanoma outcomes. We performed a retrospective cross-sectional study of 71 acral melanoma lesions subjected to sentinel lymph node biopsy at one Brazilian referral center. Cox model univariate analysis showed that both DOI and Breslow thickness predicted melanoma specific survival (HR 1.12; p = 0.0255 and HR 1.144; p = 0.0006, respectively), although Kaplan Meier curve was only significant for Breslow (χ 2 = 5.792; p = 0.0161) and not for DOI (χ 2 = 0.2556; p = 0.6132). Sentinel lymph node status and presence or absence of ulceration also predicted specific survival in patients with acral melanoma (χ 2 = 6.3514; p = 0.0117 and χ 2 = 4.2793; p = 0.0386, respectively). Multivariate analysis, however, demonstrated that Breslow depth was the only independent parameter for predicting acral melanoma specific survival (HR 1.144; p = 0.0006). Even though Breslow thickness remains the main predictor for survival in acral melanoma, it is not a perfect parameter. The introduction of DOI in this context opens new perspectives for predicting acral melanoma outcomes. • Depth of invasion (DOI) was introduced as a new parameter among acral melanomas (AM). • DOI can predict AM survival outcome just in univariate analysis. • Positive sentinel node and ulceration are associated with worse survival outcome. • In multivariate analysis Breslow was the only independent parameter for AM prognosis.