Desmoplastic melanoma - the step-child in the melanoma family?
OBJECTIVE
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.
Department of Surgery, Section of Surgical Oncology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. wasif.nabil@mayo.edu
Nabil
N
Wasif
Richard J
RJ
Gray
Barbara A
BA
Pockaj
D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012042:Registries; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015996:Survival Rate