title: Is sentinel lymph node biopsy warranted for desmoplastic melanoma? A systematic review.
abstract: BACKGROUND
  Desmoplastic melanoma (DM) is an uncommon malignancy associated with a high local recurrence rate. The aim of this systematic review was to determine the positivity rate of sentinel lymph node biopsy (SLNB) in patients with DM. The secondary outcome was to establish if SLNB is warranted for both pure DM (PDM) and mixed DM (MDM).
  
  
  METHODS
  A full systematic literature review of SLNB in DM was performed by two authors in January 2016. Ovid MEDLINE, Ovid EMBASE and the Cochrane Central Register of Controlled Trials were searched.
  
  
  RESULTS
  Sixteen studies involving 1519 patients having SLNB in DM were included, of which 99 patients had positive SLNB (6.5%). Two articles reported a significantly reduced disease-free survival (DFS) with positive SLNB and three published a reduced melanoma-specific survival (MSS). Six studies compared SLNB in MDM and PDM. Of the 275 patients, 38 (13.8%) had a positive SLNB in MDM compared to 17 of 313 patients (5.4%) with positive SLNB in PDM.
  
  
  CONCLUSIONS
  Rates of positive SLNB in DM are reduced compared to other variants of melanoma; however, nodal status may still predict DFS and MSS. MDM is associated with a higher rate of micro-metastases to regional lymph nodes than PDM, and DFS and MSS may be lesser in MDM than in PDM. We would recommend the consideration of SLNB in MDM. However, with such low rates of positive SLNB in PDM, and in the absence of high-risk features to stratify patients, we would not recommend SLNB in PDM.
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom. Electronic address: Jonathan.a.dunne@gmail.com.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Dunne
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors.forename: Justin C R
authors.initials: JC
authors.lastname: Wormald
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: Steele
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Woods
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors.forename: Joy
authors.initials: J
authors.lastname: Odili
authors.affiliation: Department of Plastic and Reconstructive Surgery, St George's Hospital, Blackshaw Rd, Tooting, London, SW17 0QT, United Kingdom.
authors.forename: Barry W E M
authors.initials: BW
authors.lastname: Powell
mesh_terms: D006801:Humans; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000175:diagnosis* / Q000556:secondary; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000556:secondary*; D000096142:Cutaneous Malignant Melanoma
keywords: Desmoplastic; Melanoma; Sentinel node