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Desmoplastic neurotropic melanoma of the head and neck: The role of radiation therapy

Authors

  • Timothy D. Anderson MD,

    1. Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Randal S. Weber MD,

    1. Department of Otorhinolaryngology Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Dupont Guerry MD,

    1. Department of Hematology and Oncology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • David Elder MD,

    1. Department of Pathology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Lynn Schuchter MD,

    1. Department of Hematology and Oncology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Laurie A. Loevner MD,

    1. Department of Radiation Oncology, University of Pennsylvania Medical Center, 2nd Floor Donner Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104
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  • David I. Rosenthal MD

    Corresponding author
    1. Department of Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
    Current affiliation:
    1. Department of Radiation Oncology, Box 097, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030
    • Department of Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Dennis H. Kraus, MD, Section Editor

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. © 2002 Wiley Periodicals, Inc.

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