title: Desmoplastic neurotropic melanoma of the head and neck: the role of radiation therapy.
abstract: BACKGROUND
  Desmoplastic neurotropic melanoma (DNM) is an uncommon cutaneous melanoma variant with pronounced neurotropism. In contrast to ordinary melanomas, locoregional recurrences are common and distant metastasis are uncommon in patients with DNM. Local control with surgery and radiation therapy may assume a more important role in this variant of melanoma. We present a case of an unresectable skull base recurrence of DNM that was controlled using radiation therapy alone and review the literature.
  
  
  METHODS
  Case report with 36-month follow-up.
  
  
  RESULTS
  The patient is a 68-year-old with multiple recurrences of a DNM that originated on the forehead. After extensive surgery, including total parotidectomy and temporal bone resection, the patient had an unresectable recurrence of the skull base develop. This was treated with definitive radiation therapy, resulting in a complete response. The patient has had no evidence of recurrence at 3 years.
  
  
  CONCLUSIONS
  DNM is a locally aggressive type of melanoma with a high risk of local recurrence that can be radioresponsive. The incidence of distant metastasis is low, so aggressive treatment to control local disease is warranted. This may include surgery plus adjuvant radiation therapy or definitive radiotherapy for unresectable recurrences.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Anderson
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Dupont
authors.initials: D
authors.lastname: Guerry
authors.forename: David
authors.initials: D
authors.lastname: Elder
authors.forename: Lynn
authors.initials: L
authors.lastname: Schuchter
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Loevner
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D019292:Skull Base Neoplasms / Q000532:radiotherapy* / Q000556:secondary*