Desmoplastic neurotropic melanoma of the head and neck: the role of radiation therapy.
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.
Anderson
Timothy D
TD
Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
Weber
Randal S
RS
Guerry
Dupont
D
Elder
David
D
Schuchter
Lynn
L
Loevner
Laurie A
LA
Rosenthal
David I
DI
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*