Clinical and pathological features of metastases of primary cutaneous desmoplastic melanoma

Murali, Rajmohan; Zannino, Diana; Synnott, Maria; McCarthy, Stanley W.; Thompson, John F.; Scolyer, Richard A.

doi:10.1111/j.1365-2559.2011.03808.x

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…10,13 However, histologic subtype was not evaluated in these two studies. 10 Murali et al 15,30 showed that SLN metastases occurred more often in mixed (8.5 %) versus pure (4.9 %) DM, although this was not a significant difference ( p = .25), and in a second study they found no significant predictors of SLN disease. Mohebati et al 16 reported on head and neck DM and found no SLN metastases in 15 and 8 patients with pure and mixed DM, respectively.…”

Section: Discussionmentioning

confidence: 96%

Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?

Han

Zager

et al. 2013

Ann Surg Oncol

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Background The utility of sentinel lymph node biopsy (SLNB) for desmoplastic melanoma (DM) is debated. We describe a large single-institution experience with SLNB for DM to determine clinicopathologic factors predictive of SLN metastasis. Methods Retrospective review identified 205 patients with DM who underwent SLNB from 1992 to 2010. Clinicopathologic characteristics were correlated with SLN status and outcome. Results Median age was 66 years, and 69 % of patients were male. Median Breslow thickness was 3.7 mm. In 128 cases (62 %), histologic subtype data was available; 61 cases (47.7 %) were mixed and 67 cases (52.3 %) were pure DM. A positive SLN was found in 28 cases (13.7 %); 24.6 % of mixed and 9 % of pure DM had SLN metastases. Multivariable analysis demonstrated that after controlling for age, histologic subtype correlated with SLN status [odds ratio (OR): 3.0 for mixed vs pure, 95 % confidence interval (95 % CI): 1.1–8.7; p < .05]. Completion lymph node dissection was performed in 24 of 28 positive SLN patients with 16.7 % of cases having additional nodal disease. After a median follow-up of 6.3 years, 38 patients developed recurrence and 61 patients died. Positive SLN patients had a significantly higher risk of melanoma-related death compared with negative SLN patients (p = .01). Conclusions The overall risk for SLN metastasis for DM is 13.7 % and is significantly higher for mixed (24.6 %) compared with pure (9.0 %) DM. We believe that these rates are sufficient to justify consideration of SLNB for both histologic variants, especially since detection of SLN disease appears to predict a higher risk for melanoma-related death.

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Section: Discussionmentioning

confidence: 96%

Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?

Han

Zager

et al. 2013

Ann Surg Oncol

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“…22 In yet another series of patients with metastatic desmoplastic melanoma, the mixed subtype (hazard ratio 6.17; CI 1.61-23.81; P ¼ 0.019) was an independent predictor of poorer overall survival in a multivariate analysis. 28 Thus, the higher mortality of the mixed subtype appears to be well established. However, immunohistochemical and genetic differences between these groups have not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

et al. 2012

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Desmoplastic melanoma is subclassified into pure and mixed variants with a higher rate of lymph node metastasis in the latter. Given that reasons for these biological differences are not currently known, we investigated these subtypes with techniques that included genetic and immunohistochemical analyses of 43 cases of desmoplastic melanoma (24 pure, 19 mixed). Direct DNA sequencing was performed on BRAFV600E, RET gene (coding region on exon 11) and KIT (exons 11, 13 and 17). Immunohistochemical stains were performed with antibodies to markers of significance with respect to biological potential of nevomelanocytic proliferations and/or desmoplastic melanoma (Ki-67, CD117, nestin, clusterin, SOX10 and CD271/p75NTR). Polymorphism at the RET coding region (RETp) was noted in 33% of pure (8/24 cases) versus 24% of mixed (4/17 cases); BRAFV600E was absent in all cases of pure (0/24 cases) versus 6% of mixed (1/17 cases); no mutations were found in any of the cases on analyses of exons 11, 13 and 17 of the c-KIT gene (P ¼ NS for all). For immunohistochemical analyses of pure versus mixed: mean percentage of Ki-67 nuclear positivity was 5% (s.d. ¼ 5.6) versus 28% (s.d. ¼ 12.6, Po0.001); CD117 stained 26% (6/23 cases) versus 78% (14/18 cases, Po0.01); nestin stained 83% (n ¼ 19/23 cases) versus 89% (16/18 cases, P ¼ NS); clusterin stained 4% (1/23 cases) versus 6% (1/18 cases, P ¼ NS); SOX10 87% (20/23 cases) versus 94% (17/18 cases, P ¼ NS) and CD271 stained 61% (14/23 cases) versus 67% (12/18 cases, P ¼ NS). Increased CD117 staining in the mixed variant suggests that alterations in the KIT protein may be involved in tumor progression. In addition, the proliferative index of the mixed variant was higher than that of the pure variant.

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“…DM patients represent an older population, and in our study, a considerable proportion of deaths with known causes were not due to melanoma, so it is not surprising that older age would be correlated with worse OS. Murali et al also reported that gender significantly predicted OS, [ 24 ] and two studies have correlated MR with survival [ 5 , 16 ]. In contrast to prior studies that have reported a significant association between histologic subtype and RFS or MSS, [ 2 , 3 , 8 ] our study did not find histologic subtype to be a significant predictor of RFS, MSS or OS on multivariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma

Han

Zhao

et al. 2015

PLoS ONE

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Background and ObjectivesDesmoplastic 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.MethodsRetrospective review from 1993 to 2011 identified 316 patients with primary desmoplastic melanoma. Clinicopathologic characteristics were correlated with nodal status and outcome.ResultsFifty-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/mm2 and nodal status significantly predicted melanoma-specific survival (p<0.05).ConclusionsNodal 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.

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Clinical and pathological features of metastases of primary cutaneous desmoplastic melanoma

Abstract: The cellular composition of primary DM correlates with that of metastatic DM and with outcome. It is important to consider the possibility of primary or metastatic DM when examining tumours composed of spindle cells.

Cited by 19 publications

References 22 publications

Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?

Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma

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