Clinically amelanotic or hypomelanotic melanoma: Anatomic distribution, risk factors, and survival

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Background: The recognition and diagnosis of clinically amelanotic or hypomelanotic melanoma is a challenge. Objective: This study aimed to examine the anatomic distribution and risk factors associated with clinically amelanotic or hypomelanotic melanoma and compare the survival of patients with clinically amelanotic or hypomelanotic melanoma with that of patients with pigmented melanoma. Methods: A prospective cohort study of all cases of primary invasive melanoma managed at a tertiary referral center was performed. Results: There were a total of 3913 invasive melanomas, and 384 (9.8%) were clinically amelanotic or hypomelanotic. Skin phototype I; red as well as blonde hair color; actinic keratoses; nodular, desmoplastic, and lentigo maligna subtype; increased Breslow thickness; and mitoses were independently associated with amelanotic or hypomelanotic melanoma (P <.05). After adjustment for subtype and thickness, the face, ears, lateral aspect of the neck, upper portion of the arm, posterior aspect of the forearm, dorsal aspect of the hand, and anterior aspect of the lower portion of the leg were associated with increased odds of amelanotic or hypomelanotic melanoma when compared with the upper portion of the back (P <.05). Mortality risk from melanoma appeared greater for amelanotic or hypomelanotic melanoma than for pigmented melanoma (hazard ratio, 1.5; 95% confidence interval, 1.1-2.1) but was similar once Breslow thickness was taken into account. Limitations: Single tertiary referral center. Conclusion: Although clinically amelanotic or hypomelanotic melanoma can occur on all body sites, it is more common on chronically sun-exposed areas. Clinicians should have an increased index of suspicion in patients with a sun-sensitive skin phenotype, red hair, and associated actinic keratoses.

Original languageEnglish
Pages (from-to)645-651.e4
Number of pages11
JournalJournal of the American Academy of Dermatology
Issue number4
Publication statusPublished - 1 Oct 2018


  • amelanotic melanoma
  • anatomic location
  • hypomelanotic melanoma
  • pigmentation
  • survival

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