Acral lentiginous melanoma (ALM), a cutaneous melanoma subtype, exhibits a poorer prognosis than non-acral cutaneous melanoma (NACM). The neutrophil-to-lymphocyte ratio (NLR) is emerging as a prognostic indicator across diverse cancers.

We explored the baseline NLR disparities between ALM and NACM, and the NLR's prognostic significance in patients with ALM.

We reviewed records of patients with ALM and NACM diagnosed between 1997 and 2022, analyzing medical data.

Among 327 and 159 patients with ALM and NACM, respectively, baseline NLR varied based on distinct clinicopathological factors between ALM and NACM. In stage 3-4 melanomas, the median NLR for ALM (2.18; interquartile range, 1.70-3.08) significantly surpassed NACM (1.74; interquartile range, 1.33-2.53) (P=0.029). In patients with ALM, high NLR (hazard ratio, 1.64; 95% confidence interval, 1.02-2.66; P=0.043) was independently correlated with poor progression-free survival when adjusting for ulceration, Breslow thickness ≥2 mm, and nodal invasion.

Single-center, retrospective design.

Advanced-stage ALM exhibited a significantly higher baseline NLR compared to that of NACM. Evaluating baseline NLR could provide valuable prognostic insights for patients with ALM.