Plantar malignant melanoma - a challenge for early recognition

The incidence of malignant melanoma has been continuously increasing over t he last few decades. Non-plantar melanomas are nowadays usually diagnosed a nd treated surgically at an early stage. In contrast, melanoma in a plantar location is usually diagnosed at an advanced tumour stage, conferring a po or prognosis. To discover the reasons for this remarkable difference in rec ognition and prognosis, we analysed our cases of plantar malignant melanoma in a retrospective study. From 1990 to 1997, we treated 925 melanoma patie nts. Of these, 68 cases (7%) were classified as plantar melanoma. For non-p lantar melanoma patients the mean age was 52.6 years, the mean Clark level was 2.8 and the mean tumour depth was 1.22 mm. In contrast, the mean age of patients with plantar melanoma was 63.3 years, the mean Clark level was 3. 61 and the mean tumour depth was 2.55 mm. The mean time between the first o bservation of the plantar skin lesion and the first consultation with a phy sician (patients' delay) was 4.8 years and, on average, it took an addition al 7 months before adequate surgical treatment was performed (physicians' d elay). The prognosis of our patients was poor. In 98.5% (n = 67) further me tastases were observed on followup. Since there is still no cure for advanc ed plantar malignant melanoma, the early detection and subsequent surgical treatment of plantar melanoma is decisive for the prognosis. Based on our r esults, the poor survival can be improved by a significant reduction in the time period between the first observation of a plantar skin lesion and sur gical treatment. Therefore there is an urgent need for special preventive h ealth care campaigns to reduce significantly both the patients' and the phy sicians' delay. (C) 2000 Lippincott Williams & Wilkins.