Prognosis of Melanoma-Reply

In Reply.—

Dr Silvers raises the question of whether black patients with melanoma, after controlling for the location of the melanoma lesion to volar and subungual primary sites, have a worse prognosis than their white counterparts. This question is indirectly answered in Table 2 of the article; we initially controlled for histology of the acral lentiginous type of lesion and subsequently constructed actuarial survival curves for the white and black populations. Acral lentiginous lesions are almost exclusively limited to the volar or subungual surfaces of patients with melanoma. In our black population, 22 patients had acral lentiginous histology, with 86% of these lesions present on palmar, plantar, or subungual locations. The remaining lesions were mucosal primary lesions that weretainedalso classified as acral lentiginous. The Figure shows median survival of 33.7 months in blacks and 110.7 months in whites with acral lentiginous melanomas. ThePvalue for the difference in