Ulceration was a negative prognostic feature that was used to subcategorize cutaneous melanoma patients, along with tumor thickness. However, the impact of ulceration on the prognosis of acral melanoma (AM) was debatable. For a study, the researchers sought to examine the impact of ulceration on prognosis in AM and the variation in Breslow thicknesses and clinical stages. Patients diagnosed with AM between January 2000 and December 2017 were researched in a multi-center retrospective outline. The multivariate Cox proportional hazards model and log-rank test analyzed differences in melanoma-specific survival (MSS) between patients with and without ulceration. Ulceration was determined in 62.6% of the 1,053 individuals who took part in the research. Patients with ulceration had a lower median MSS than those without [66.1 months (95% CI 60.0-86.0) vs not achieved; hazard ratio (HR)=1.41, 95% CI 1.09-1.82; P-value=0.012] after a median follow-up of 61 months. The survival curves of individuals with thin (≤1mm) melanoma with vs without ulceration markedly separated over time (P-value<.001). For melanomas with a thickness greater than 1 mm (subgroups T2, T3, and T4; all P-values >0.05) or stage III disease (HR=1.09, 95% CI 0.71-1.68, P-value=0.391), there was no link between ulceration and MSS. Ulceration was an independent negative prognostic risk for patients with AM, but its influence varies depending on Breslow thickness and clinical stage. Patients with thin (≤1mm) melanoma had a better prognosis with ulceration; however, there was no link between ulceration and survival in intermediate/thick or stage III AM.