Vol. 9, Issue 2, Part A (2025)

Acral malignant melanoma (AM) is an aggressive subtype with distinct genetic and clinical features, particularly prevalent in Asian populations. This study investigated prognostic factors, surgical outcomes and molecular biomarkers to improve management strategies. A retrospective analysis of 223 AM patients (2015–2021) evaluated clinical-pathological variables (ulceration, LDH, Ki-67) through Cox regression. Surgical outcomes for heel defects were compared between traditional skin grafting (n=73) and vacuum-assisted closure (VSD; n=73). Bioinformatics analysis of TCGA data identified metastasis-associated lncRNAs, validated via qPCR in melanoma cell lines. Ulceration (HR=2.34, p<0.001), lymph node metastasis (HR=1.89, p=0.002), elevated LDH (HR=2.12, p<0.001) and Ki-67 ≥50% (HR=1.76, p=0.008) independently predicted poorer survival. VSD grafting showed superior outcomes vs. traditional methods, with higher graft survival (89.2% vs. 68.5%, p<0.001) and lower infection rates (8.2% vs. 24.7%, p=0.003). Nine metastasis-linked lncRNAs were identified, including WFDC21P (HR=1.92, p=0.004) and SH3PXD2A-AS1 (HR=0.61, p=0.018). PPI analysis highlighted CD86 as a druggable hub gene. This study establishes validated prognostic markers, demonstrates VSD’s efficacy in heel reconstruction and reveals novel lncRNA signatures for AM metastasis. These findings guide risk stratification, surgical practice and future targeted therapies.