Pathologic deep margin distance and prognosis in invasive acral melanoma of the sole
BACKGROUND AND OBJECTIVES: The optimal depth of resection margins in melanoma remains unclear. While excessive deep excision may not provide additional oncologic benefit, preservation of plantar subcutaneous fat is important in acral melanoma of the sole. This study evaluated the prognostic significance of pathologically measured deep margin distance. MATERIALS AND METHODS: This multi-institutional retrospective study included patients with invasive sole acral melanoma treated with wide local excision. Deep margin distance was analyzed as a continuous variable using multivariable Cox models (per 1-mm increase). Additional analyses used a prespecified 3-mm cut-off, including Kaplan-Meier, Cox regression, and propensity score matching. RESULTS: A total of 434 patients were included. Deep margin distance was not associated with LRFS (HR 0.99, p = 0.72), DFS (HR 0.97, p = 0.23), or OS (HR 0.99, p = 0.71). No significant differences were observed between groups using the 3-mm cut-off in the overall cohort or after matching. Exploratory analyses with a 2-mm cut-off showed similar results. CONCLUSIONS: Deep margin distance was not associated with survival outcomes in invasive sole acral melanoma. These findings may help guide deep excision planning in conventional wide local excision settings.
Authors
- Hiraku Kokubu (ORCID: https://orcid.org/0000-0003-4023-367X)
- Naoya Yamazaki (ORCID: https://orcid.org/0000-0002-9638-0428)
- Hiroshi Uchi (ORCID: https://orcid.org/0000-0003-2526-3504)
- Akiko Kishi (ORCID: https://orcid.org/0009-0007-5512-7155)
- Satoshi Fukushima (ORCID: https://orcid.org/0000-0002-0622-7682)
- Takafumi Kadono (ORCID: https://orcid.org/0000-0002-6425-2392)
- Yoshiyasu Umeda (ORCID: https://orcid.org/0000-0003-3641-2528)
- Reiichi Doi
- Shigeto Matsushita (ORCID: https://orcid.org/0000-0003-2001-5341)
- Yukiko Kiniwa (ORCID: https://orcid.org/0000-0003-3757-7375)
- Keiko Manabe (ORCID: https://orcid.org/0000-0002-8074-5787)
- Takeo Maekawa (ORCID: https://orcid.org/0000-0001-5865-8487)
- Naohito Hatta (ORCID: https://orcid.org/0000-0003-1590-8348)
- Takuya Miyagawa (ORCID: https://orcid.org/0000-0002-4471-1635)
- Takeru Funakoshi (ORCID: https://orcid.org/0000-0002-8893-4590)
- Azusa Hiura
- Takashi Inozume (ORCID: https://orcid.org/0000-0001-7054-1863)
- Hisashi Uhara (ORCID: https://orcid.org/0000-0001-5391-3397)
- Eiji Nakano (ORCID: https://orcid.org/0000-0001-7632-8182)
- Masahiro Marshall Nakagawa (ORCID: https://orcid.org/0000-0002-6420-2555)
- Takahiro Haga (ORCID: https://orcid.org/0000-0003-2680-7614)
- Yuki Ichigozaki
- Shigeru Koizumi (ORCID: https://orcid.org/0000-0002-7213-4708)
- Kenta Nakama (ORCID: https://orcid.org/0000-0002-0651-1480)
- Tatsuya Takenouchi (ORCID: https://orcid.org/0000-0002-6818-944X)
- Shoichiro Ishizuki (ORCID: https://orcid.org/0009-0001-9939-370X)
- Yuki Yamamoto (ORCID: https://orcid.org/0000-0001-9317-7267)
- Dai Ogata (ORCID: https://orcid.org/0000-0002-1335-7100)
- Tomoe Nakagawa (ORCID: https://orcid.org/0000-0003-4492-9869)
- Yutaka Kuwatsuka (ORCID: https://orcid.org/0000-0002-8444-6792)
- Toshihiro Takai (ORCID: https://orcid.org/0000-0001-6969-1653)
- Masahito Yasuda (ORCID: https://orcid.org/0000-0002-2907-640X)
- Shiro Iino
- K. Inafuku (ORCID: https://orcid.org/0009-0008-3426-1432)
- Takahide Kaneko (ORCID: https://orcid.org/0000-0002-6219-6665)
- Toshihiko Hoashi (ORCID: https://orcid.org/0000-0002-5429-621X)
- Ayano Maruyama (ORCID: https://orcid.org/0000-0003-2519-8378)
- Yasuhiro Nakamura (ORCID: https://orcid.org/0000-0002-3664-5818)
- Shoichiro Minami (ORCID: https://orcid.org/0000-0003-2778-3642)
- Hiroshi Kitagawa (ORCID: https://orcid.org/0000-0002-1432-4896)
- Masashi Ishikawa (ORCID: https://orcid.org/0000-0001-6631-3913)
- Makoto Nagai (ORCID: https://orcid.org/0000-0003-3638-706X)
- Masaru Arima
- Utsugi Iwasawa (ORCID: https://orcid.org/0009-0009-4143-2700)
- Kenji Asagoe
- Shusaku Ito
- Sayuri Sato
- Yosuke Yamamoto
- Takamichi Ito
Institutions
- Kurume University (JP)
- University of Fukui (JP)
- Hamamatsu University (JP)
- Kyushu University (JP)
- Hyogo Medical University (JP)
- Shinshu University (JP)
- Sapporo Medical University (JP)
- Fujita Health University (JP)
- University of Tsukuba (JP)
- Jichi Medical University (JP)
- Asahikawa Medical University (JP)
- Chiba University (JP)
- Shiga University of Medical Science (JP)
- St. Marianna University School of Medicine (JP)
- Gunma University (JP)
- Mie University (JP)
- Kawasaki Medical School (JP)
- Wakayama Medical University (JP)
- Keio University (JP)
- Hamamatsu University School of Medicine (JP)
- Kyoto Prefectural University of Medicine (JP)
- Toyama Prefectural Central Hospital (JP)
- Niigata Cancer Center Hospital (JP)
- National Hospital Organization Kyushu Cancer Center (JP)
- Takamatsu Red Cross Hospital (JP)
- Kurume University Medical Center (JP)
- Tokyo Metropolitan Hiroo Hospital (JP)
- Saitama Cancer Center (JP)
- Itami City Hospital (JP)
- Saitama International Medical Center (JP)
- National Hospital Organization (JP)
- Juntendo University Urayasu Hospital (JP)
- Kagoshima Medical Center (JP)
- Hitachi General Hospital (JP)
- Okayama Medical Center (JP)
- Nippon Medical School Hospital (JP)
- Hyogo Prefectural Cancer Center (JP)
- Nagasaki University Hospital (JP)
- Jichi Medical University Saitama Medical Center (JP)
- Toranomon Hospital (JP)
- Kimitsu Chuo Hospital (JP)
- National Cancer Center Hospital (JP)
- The University of Tokyo (JP)
- Wakayama University (JP)
- Saitama Medical University (JP)
- Teikyo University (JP)
- Kumamoto University (JP)
Publication Details
- Journal
- JDDG Journal der Deutschen Dermatologischen Gesellschaft
- Published
- 2026-11-02
- DOI
- https://doi.org/10.1111/ddg.70474
- Primary Topic
- Cutaneous Melanoma Detection and Management
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Japan Agency for Medical Research and Development