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Desmoplastic melanoma – the step-child in the melanoma family?

Authors


  • No financial disclosures or conflicts of interest for any of the authors.

Abstract

Background and Objectives

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. J. Surg. Oncol. 2011; 103:158–162. © 2010 Wiley-Liss, Inc.

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