Cutaneous Melanoma Care in Low-Resource Settings: Surgical Disparities in Global Reconstructive Oncology

Abstract

Background: Cutaneous melanoma poses a major global health challenge, with marked disparities in incidence and outcomes—especially in low- to middle-income countries (LMICs), where inadequate surveillance and systemic barriers obscure its true burden. Acral lentiginous melanoma (ALM), an aggressive and diagnostically challenging subtype, disproportionately affects darker individuals and remains understudied in low-resource settings. Methods: A global and regional synthesis of peer-reviewed literature, cancer registry data, and clinical outcomes was conducted, with emphasis on ALM subtype distribution, surgical access, and reconstructive capacity across diverse socioeconomic settings. South Africa’s Eastern Cape was used as a contextual case study to illustrate systemic constraints in LMICs. Results: Despite lower melanoma incidence in LMICs, ALM confers a disproportionate mortality burden—exacerbated by diagnostic delays and limited therapeutic options. Among Black African and Asian populations, lesions frequently affect anatomically complex sites, such as the palms and soles. In low-resource settings such as South Africa’s Eastern Cape, the absence of specialized reconstructive services amplifies surgical disparities, impeding oncological margin clearance and increasing the risk of functional loss and preventable amputation. Inadequate access to adjuvant therapies and radiotherapy infrastructure further compromises survival. Conclusions: The management of ALM in LMICs embodies a nexus of oncological urgency and surgical inequity. Bridging disparities demands a multifaceted approach: investment in regional cancer registries, expansion of reconstructive surgical capacity, and integration of melanoma awareness into public health frameworks. By situating ALM within broader health system deficiencies, this review advocates for equity-driven policy and infrastructure initiatives to improve global melanoma outcomes—particularly in underserved populations.