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Desmoplastic melanoma – the step‐child in the melanoma family?
Author(s) -
Wasif Nabil,
Gray Richard J.,
Pockaj Barbara A.
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21778
Subject(s) - medicine , melanoma , biopsy , wide local excision , multivariate analysis , radiation therapy , adjuvant radiotherapy , mucosal melanoma , sentinel node , breslow thickness , surgery , population , epidemiology , dermatology , oncology , sentinel lymph node , cancer , environmental health , cancer research , breast cancer
Background and Objectives Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma. Our goal was to study the surgical management of DM, identify prognostic factors, and impact of treatment options. Methods Patients with DM (n = 1,735) were identified from the Surveillance, Epidemiology, and End Results database (1988–2006). Results The median age of the study population was 69 years and overall survival (OS) at 5 years 65%. DM was more common in males (65%), most commonly found on the head and neck (51%), and had a mean thickness of 2.97 mm. Patients undergoing a wide local excision (WLE; ≥1 cm) had improved 5‐year OS compared to a simple excision (<1 cm) or biopsy alone (67% vs. 60% vs. 45%, respectively, P < 0.001). Of 505 patients (29%) undergoing sentinel node biopsy (SLNB), only 14 (2.8%) were positive. Traditional prognostic factors such as Breslow thickness, nodal positivity, and ulceration did not predict survival. On multivariate analysis only adjuvant radiation therapy [HR 1.65 (95% CI 1.17–2.31)] and WLE correlated with survival [HR 0.47 (95% CI 0.32–0.69)]. Conclusions Desmoplastic melanoma does not share traditional prognostic factors with the melanoma family. Surgical resection with wide margins is needed to optimize survival and routine SLNB may be unnecessary. J. Surg. Oncol. 2011; 103:158–162. © 2010 Wiley‐Liss, Inc.