Received: 11 February 2017 Accepted: 29 August 2017 Published on: 20 October 2017
Treatment and outcomes of melanoma in Asia: Results from the
National Cancer Centre Singapore
Yi Lin Teh
Wei Lin Goh
Sze Huey Tan
Alisa Noor Hidayah Sairi
Khee Chee Soo
Mann Hong Tan
National Cancer Centre Singapore, Singapore
Singapore General Hospital, Singapore
Mohamad Farid, Division of Medical Oncology,
National Cancer Centre Singapore, 11 Hospital
Drive, Singapore 169610.
These authors contributed equally to the
Background: Acral melanoma (AM) and mucosal melanoma (MM) make up more than half of
melanomas in Asia but comprise only 5% of cases in Caucasians, where cutaneous melanoma (CM)
predominates. AM and MM are thought to be genetically and biologically distinct from CM. We
report the characteristics and outcomes of melanoma patients from the National Cancer Centre
Methods: Case records of 210 patients treated between 2002 and 2014 were reviewed.
Results: Median follow-up was 2.5 years. CM, AM and MM made up of 37.6%, 33.8% and 16.2%
of cases, respectively, with 6.2% each having ocular melanoma and unknown primary. Caucasians
made up 16.2% of patients, accounting for 36.7% of CM but only 2.8 of AM and 2.9% of MM.
Patients with MM (2.9% stage I, 14.7% stage IV) presented with higher American Joint Commit-
tee on Cancer (AJCC) stage than those with AM (16.9% stage I, 5.6% stage IV) or CM (24.1% stage
I, 8.9% stage IV) (P = 0.01). Median overall survival (OS) was 5.7 years for all patients, and 1.0
year for metastatic disease. Considering stage I–III disease, multivariable Cox regression analysis
demonstrated age ≥60 years and higher stage to be independent adverse prognostic factors for
RFS and OS. Sentinel lymph node biopsy, undertaken for 56 stage I–III patients (25 AM, 31 CM)
did not inﬂuence outcome.
Conclusion: Our study reinforces the known unique clinicopathologic features of melanomas in
Asians where AM and MM predominate. Age and stage remain the most critical prognostic factors
across all subtypes.
acral, Asian, melanoma, mucosal, outcomes, treatment
Melanoma is an aggressive malignancy associated with signiﬁcant clin-
ical, biological and epidemiological heterogeneity. It affects Caucasian
populations more commonly than peoples with pigmented skin, includ-
ing Asians. Data from the National Cancer Institute Surveillance, Epi-
demiology and End Results Program (SEER) revealed an age-adjusted
incidence of 21.9 persons per 100 000 population per year in non-
Hispanic “whites,” as opposed to < 5 per 100 000 for all other ethnic-
ities; the incidence in Asians was 1.5 per 100 000.
In spite of these
ethnogeographic disparities in incidence, advanced melanoma has a
universally poor prognosis, with 5-year survival in metastatic disease
The modern taxonomy of melanocytic neoplasia derives from a sem-
inal publication by Curtin and colleagues who established four clini-
cally deﬁned categories that are genetically distinct.
The ﬁrst two cat-
egories are cutaneous melanomas (CMs) developing in sun-exposed
skin that are distinguished by the extent of cumulative sun damage
Asia-Pac J Clin Oncol. 2018;14:e95–e102.
2017 John Wiley & Sons Australia, Ltd e95wileyonlinelibrary.com/journal/ajco