title: Clinicopathologic predictors of survival in patients with desmoplastic melanoma.
abstract: OBJECTIVE
  Desmoplastic melanoma is a unique subtype of melanoma which typically affects older patients who often have comorbidities that can adversely affect survival. We sought to identify melanoma-specific factors influencing survival in patients with desmoplastic melanoma.
  
  
  METHODS
  Retrospective review from 1993 to 2011 identified 316 patients with primary desmoplastic melanoma. Clinicopathologic characteristics were correlated with nodal status and outcome.
  
  
  RESULTS
  Fifty-five patients (17.4%) had nodal disease: 33 had a positive sentinel lymph node biopsy and 22 developed nodal recurrences (no sentinel lymph node biopsy or false-negative sentinel lymph node biopsy). Nodal disease occurred more often in younger patients and in cases with mixed compared with pure histology (26.7% vs. 14.6%); both of these variables significantly predicted nodal status on multivariable analysis (p<0.05). After a median follow-up of 5.3 years, recurrence developed in 87 patients (27.5%), and 111 deaths occurred. The cause of death was known in 79 cases, with 47 deaths (59.5%) being melanoma-related. On multivariable analysis, Breslow thickness, mitotic rate ≥ 1/mm(2) and nodal status significantly predicted melanoma-specific survival (p<0.05).
  
  
  CONCLUSIONS
  Nodal status predicts melanoma-specific survival in patients with desmoplastic melanoma. However, since patients with desmoplastic melanoma represent an older population, and a considerable proportion of deaths are not melanoma-related (40.5%), comorbidities should be carefully considered in making staging and treatment decisions in this population.
authors: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America.
authors: Dale
authors: D
authors: Han
authors: Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, United States of America.
authors: Gang
authors: G
authors: Han
authors: Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida, United States of America.
authors: Xiuhua
authors: X
authors: Zhao
authors: Department of Radiation Oncology, Florida Hospital, Orlando, Florida, United States of America.
authors: Nikhil G
authors: NG
authors: Rao
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America; Departments of Pathology and Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America.
authors: Jane L
authors: JL
authors: Messina
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America.
authors: Suroosh S
authors: SS
authors: Marzban
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America; Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America.
authors: Amod A
authors: AA
authors: Sarnaik
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America; Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America.
authors: C Wayne
authors: CW
authors: Cruse
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America; Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America.
authors: Vernon K
authors: VK
authors: Sondak
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America; Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America.
authors: Jonathan S
authors: JS
authors: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012008:Recurrence; D016019:Survival Analysis; D055815:Young Adult