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The study included 168 patients with invasive acral melanoma who were followed for \u22653\u00a0years. We evaluated patient demographics, stages, clinicopathological features, anatomic site of melanoma including nail versus volar surface, and degree of melanoma pigmentations, sentinel lymph node biopsy results, and the first metastasis sites. Of the 168 patients (mean age 64.5\u00a0years; 52.4% male), 43 (25.6%) had invasive melanoma without metastasis, 113 (67.3%) had invasive melanoma with a first lymph node metastasis, and 12 (7.1%) had invasive melanoma with invasive melanoma with a first distant metastasis. Advanced T stage, high mitotic rate, ulceration, and the degree of pigmentation were significant risk factors for metastasis. Amelanotic and mild pigmentation of acral melanoma was associated with first distant metastasis, whereas heavy pigmentation was associated with first lymph node metastasis. Advanced TNM stages, high mitotic rate, volar location (hazard ratio\u00a0=\u00a02.24, 95% confidence interval 1.18\u20134.26), and low\u2010pigmentation (hazard ratio\u00a0=\u00a02.02, 95% confidence interval 1.17\u20133.49) were associated with melanoma\u2010specific mortality.<\/jats:p>","DOI":"10.1111\/pcmr.12983","type":"journal-article","created":{"date-parts":[[2021,5,2]],"date-time":"2021-05-02T07:25:01Z","timestamp":1619940301000},"page":"1094-1104","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Volar location and degree of pigmentation are associated with poor survival and first metastasis pattern in acral melanoma"],"prefix":"10.1111","volume":"34","author":[{"given":"Geon Wook","family":"Ryu","sequence":"first","affiliation":[{"name":"Departments of Dermatology Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoo Duk","family":"Choi","sequence":"additional","affiliation":[{"name":"Departments of Pathology Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suna","family":"Jin","sequence":"additional","affiliation":[{"name":"Departments of Dermatology Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ik\u2010Joo","family":"Chung","sequence":"additional","affiliation":[{"name":"Departments of Hemato\u2010Oncology Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min\u2010Ho","family":"Shin","sequence":"additional","affiliation":[{"name":"Departments of Preventive Medicine Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4229-5831","authenticated-orcid":false,"given":"Sook Jung","family":"Yun","sequence":"additional","affiliation":[{"name":"Departments of Dermatology Chonnam National University Medical School Gwangju Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,5,11]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15600"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9092996"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archdermatol.2008.609"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2019.0069"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2013.06.035"},{"issue":"4","key":"e_1_2_7_7_1","first-page":"631","article-title":"Tumor progression and the nature of cancer","volume":"64","author":"Clark W.","year":"1991","journal-title":"British Journal of Dermatology"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5137-z"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0000000000000571"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.50.1114"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2013.5853"},{"issue":"2","key":"e_1_2_7_12_1","first-page":"207","article-title":"Non\u2010pigmented nodular plantar melanoma in 12 Japanese patients","volume":"136","author":"Kato T.","year":"1997","journal-title":"British Journal of Dermatology"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-020-0641-x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2020-0308-OA"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.07.029"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2017.11.017"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/CMR.0b013e32836410fe"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1992.01420040034005"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.06.004"},{"issue":"5","key":"e_1_2_7_20_1","first-page":"842","article-title":"Is the prognosis and course of acral melanoma related to site\u2010specific clinicopathological features?","volume":"20","author":"Paolino G.","year":"2016","journal-title":"European Review for Medical and Pharmacological Sciences"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2006.07368.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2007.08031.x"},{"key":"e_1_2_7_23_1","article-title":"Risk factors affecting the first metastasis of acral melanoma: Low\u2010pigmentation independently predicts a first lung metastasis","author":"Ryu G. 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