The Journal of Bone and Joint Surgery, Vol 76, Issue 6 892-898, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Melanoma of the foot
BC Barnes, HF Seigler, TS Saxby, MS Kocher and JM Harrelson
Comprehensive Cancer Center, Duke University Medical Center, Durham, North Carolina 27710.
We performed a prospective study of the results of treatment of primary
cutaneous melanoma of the foot in 282 patients to determine if there were
any factors that could predict survival. These patients were part of a
group of 1018 patients who had primary cutaneous melanoma affecting the
lower extremity. We found that 184 (65 per cent) of the 282 patients had a
tumor that extended into the reticular dermis or subcutaneous tissue (a
Level-IV or V lesion according to the system of Clark et al.). Sixty-three
patients (22 per cent) had evidence of local, regional, or distant
metastatic disease at the time of presentation. Location of the melanoma on
the plantar aspect of the foot was found to be an independent variable that
was associated with a poorer rate of survival (56 per cent at five years
and 46 per cent at ten years) compared with a dorsally located melanoma (80
per cent at five years and 67 per cent at ten years). Subungual lesions
were associated with an extremely low rate of survival (17 per cent at ten
years); however, because of the small number of subungual lesions that were
followed, the difference in survival between the patients who had a plantar
lesion and those who had a subungual lesion was not significant (p = 0.52).
Variables, in order of decreasing importance, that had independent
prognostic significance for survival of patients who had a melanoma of the
foot were the clinical stage of the lesion at the time of presentation (p
< 0.001) and the age of the patient (p < 0.03), as determined by
multivariate analysis.(ABSTRACT TRUNCATED AT 250 WORDS)