Acral Melanoma Following Trauma: A Systematic Review and Meta-Analysis

Anecdotal evidence suggests an association between trauma and the subsequent development of acral melanoma. However, good-quality supporting evidence has been lacking, prompting this review which aimed to address the uncertainty by compiling and analyzing the frequency of trauma, tumor features, disease progression, and death due to melanoma for acral site melanomas associated with trauma and cases without a trauma history. A systematic review was performed with searches of Medline, Embase and the Cochrane CENTRAL register of trials to May 15, 2025. Included studies were those that reported cases of acral melanoma and a history or absence of preceding trauma. Data were pooled using a random-effects model. The frequency of trauma with acral site melanomas, tumor features at presentation and death from melanoma were collated and analyzed. From 1448 titles, 97 studies reported cases of acral melanoma with trauma status. Two case-control studies compared the frequency of a trauma history in patients with and without acral melanomas, both reporting that a trauma history was more frequent in patients with acral melanoma (odds ratios 5.2, 95% CI 3.0-8.8 and 8.1, 95% CI 4.3-15.5). Fifty case reports and 45 multicase studies reported acral melanoma features along with trauma history. The extensive evidence analyzed in this review confirmed with considerable confidence that acral melanomas may develop after trauma. The important practical implication of the study findings is that early biopsy of any unusual acral lesion that develops or persists after prior trauma should be considered. This will allow treatment to be undertaken expeditiously if melanoma is diagnosed.