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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although exposure to the sun is recognized as the principal factor in the genesis of melanoma&#44; this tumor also arises in areas of the skin not generally exposed to the sun&#44; as is the case in acral lentiginous melanoma of the sole&#44; in which the role of UV radiation would appear insignificant&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Acral melanomas account for 2&#37; of all melanomas &#40;1&#46;5&#37; for plantar acral melanoma&#41;&#44; with an incidence of approximately 1&#46;8 cases per million population&#44; and they appear to present a poorer prognosis than melanomas at other sites&#46; This finding seems to be related to a later diagnosis&#44; although molecular biology studies have shown higher rates of mutation of <span class="elsevierStyleItalic">c-kit</span> in this subtype of melanoma&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several elements unrelated to exposure to the sun have been identified as risk factors significantly associated with the appearance of plantar acral melanoma&#44; in particular a history of deep penetrating wounds in the sole of the foot&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> exposure to agricultural chemical agents&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> drinking alcohol&#44; and a body mass index over 25&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Important genetic alterations include amplifications in chromosome region 11q3&#44; with overexpression of gene <span class="elsevierStyleItalic">CCND1</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> which predominates over mutations in <span class="elsevierStyleItalic">BRAF</span>&#44; common in sun-induced melanomas and almost absent in the acral form&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The possible role of recurrent trauma to the sole of the foot has also been implicated in the development of these lesions&#44; as the incidence of plantar acral melanoma has been reported to be higher in those areas that bear greater pressure when standing or walking&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In June 2016&#44; Minagawa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> published an interesting article on this subject in the <span class="elsevierStyleItalic">New England Journal of Medicine&#46;</span> They retrospectively analyzed the site of the tumor on the sole of the foot of 123 patients with plantar acral melanoma&#46; Fifty lesions were situated on the heel and 32 on the forefoot&#44; compared with 14 in the midfoot area that made contact with the ground and only 3 in the arch &#40;not in contact with the ground&#41;&#46; They found no significant differences in the mean Breslow thickness of the lesions in each area&#46; As can be seen&#44; the large majority of plantar acral melanomas &#40;82&#41; were located in the areas of the sole that bear greatest pressure &#40;heel and forefoot&#41;&#44; and particularly interesting is the very small number of lesions &#40;3&#41; arising in the arch&#44; an area subject to almost no pressure or trauma&#46; The relationship between pressure and recurrent trauma in some areas of the sole and the development of plantar acral melanoma in these areas is thus more clearly demonstrated&#46;</p></span>"
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Resident's Forum
RF-Acral Melanoma and Repetitive Injury to the Sole of the Foot
FR-Traumatismos repetitivos y melanoma acral plantar
P. Martín-Carrasco
Autor para correspondencia
Pablo_ronda@hotmail.com

Corresponding author.
, M.T. Monserrat-García, A. Ortiz-Prieto, J. Conejo-Mir
Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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