Clinical and Histopathological Prognostic Factors for Disease-Free Survival in Early-Stage Acral and Non-Acral Cutaneous Melanoma: A Retrospective Asian Cohort Analysis

Yu-Jen Chiu,1,2 Chiao-Yun Cheng,1 Kuan-Cheng Chen,1 Cheng-Yuan Li,3,4 Tien-Hsiang Wang,1,2 Chi-Han Tsai1 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, 11217, Taiwan; 2Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan; 3Department of Dermatology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan; 4Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, TaiwanCorrespondence: Yu-Jen Chiu, Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, 19/F, No. 201, Sec. 2, Shipai Road, Beitou, Taipei, 11217, Taiwan, Email [email protected]: Melanoma in Asian populations exhibits distinct clinicopathological features compared to Western populations. While acral melanoma (AM) is the predominant subtype among Asians, recent studies have demonstrated unique genomic profiles across melanoma subtypes within this population, suggesting underlying biological differences. Despite these observations, prognostic factors affecting disease-free survival (DFS) in early-stage melanoma remain insufficiently characterized among Asian patients. Improved DFS-based risk stratification may inform risk-adapted surveillance strategies in clinical practice. This study investigates clinicopathological factors associated with DFS in early-stage melanoma among Taiwanese patients.Methods: A retrospective analysis was performed on 186 Asian patients with early-stage melanoma. Key factors, including age, gender, tumor location, histological subtype, Breslow thickness, mitotic rate, Lymphovascular Invasion (LVI), lactate dehydrogenase (LDH) levels, and ulceration, were analyzed. Cox proportional hazards models assessed the influence of these factors on DFS.Results: Advanced age (≥ 65) was associated with poorer DFS (HR 1.87, 95% CI 1.23– 2.83, p = 0.003). Female sex was associated with a lower risk of disease recurrence compared with male sex (HR 0.657, 95% CI 0.436– 0.989, p = 0.044). Ulceration (HR 2.09, 95% CI 1.42– 3.09, p = 0.0002), Breslow thickness, and mitotic rate (HR 2.09, 95% CI 1.13– 3.86, p = 0.0183) were associated with an increased risk of disease recurrence. In the multivariate analysis, LVI (HR 8.69, 95% CI 1.73– 43.73, p = 0.009) and ulceration (HR 2.01, 95% CI 1.05– 3.85, p = 0.035) were identified as independent risk factors for worse DFS; notably, the markedly elevated hazard ratio observed for LVI should be interpreted with caution given its relatively low prevalence in the cohort.Conclusion: Clinicopathological factors, including age, gender, Breslow thickness, mitotic rate, ulceration, and LVI were associated with disease-free survival in univariate analyses. Importantly, LVI and ulceration emerged as independent prognostic factors in multivariate analysis in early-stage melanoma among Asian patients. These findings emphasize the need for tailored follow-up and management strategies to improve outcomes.Keywords: acral melanoma, disease-free survival, prognostic factors, Breslow thickness, lymphovascular invasion, Asian population