A global perspective on prognosis in acral and non-acral cutaneous melanoma: A systematic review and meta-analysis

BACKGROUND: Acral melanoma (AM) is a rare cutaneous malignancy associated with poor survival. However, prognostic differences between AM and non-acral cutaneous melanoma (NAM) remain unclear. Therefore, we conducted a systematic review and meta-analysis to compare survival outcomes between patients with AM and those with NAM. METHODS: PubMed, EMBASE, and the Cochrane Library were comprehensively searched for studies published between January 2000 and December 2025. Studies comparing the 5-year overall survival (OS) and 5-year relapse-free survival (RFS) between AM and NAM were included. Subgroup analyses were performed by disease stage and ethnicity to assess their impact on melanoma prognosis. RESULTS: Twenty studies (18 retrospective and 2 prospective cohort studies) involving 568,346 patients were included. The meta-analysis demonstrated that AM was associated with significantly lower 5-year OS than NAM (risk ratio [RR]: 0.89; 95% confidence interval [CI]: 0.86-0.92; p < 0.00001). In subgroup analyses, compared with NAM, AM was associated with poorer 5-year OS in both stage II (RR: 0.92; 95% CI: 0.88-0.96; p = 0.0003) and stage III disease (RR: 0.85; 95% CI: 0.75-0.96; p = 0.01). Additionally, patients from darker-skinned populations with AM had poorer 5-year OS than those from White populations (RR: 0.89; 95% CI: 0.83-0.95; p = 0.0006). CONCLUSION: Patients with AM exhibited markedly lower 5-year OS than those with NAM, particularly among patients with stage II and III. Moreover, individuals from darker-skinned populations with AM had poorer survival outcomes than those from White populations.