Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma

Abstract

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.

Desmoplastic melanoma

“…Of note, DM tends to present at a greater thickness compared with non‐DM cases. The median thickness for DM ranges from 2 to 4.4 mm, as reported in larger studies with over 100 patients (Table ), compared with a median thickness of 1 mm for all newly diagnosed melanomas . The reasons for this difference in thickness are unknown but may be related in part to delays in diagnosis or differences in tumor biology .…”

“…Due to the rarity of this form of melanoma, contradictory results between earlier and later studies, and the unique biologic features of this disease, an accurate picture of the clinical behavior of DM, and therefore the optimal management of this disease, has been somewhat unclear. However, new findings and studies from recent years have begun to provide further insight for clinicians in managing patients with DM . This study will provide a contemporary overview of this disease and will review the literature regarding the management of DM.…”

High response rate to PD-1 blockade in desmoplastic melanomas

“…Thirty-seven patients (62%) had visceral metastases or elevated lactate dehydrogenase (M1c disease), which are recognized makers of poor prognosis. 7 Histological sub-classification as pure (n = 25), mixed (n = 30) or indeterminate (n = 5) DM subtypes 8 was reported by the local pathologists. All cases had the distinctive diagnostic features of DM with abundant connective tissue surrounding the tumour cells, which can be highlighted by Masson’s trichrome stain (examples in Figure 1a, with the collagenous stroma stained in blue).…”

Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases

“…[4][5][6][7][8][9][10][19][20][21][22][23][24] DM is a rare variant of melanoma, typically arising in chronically sun-damaged skin on the head and neck in elderly patients. 4,[18][19][20][21][22][23][24][25][26][27][28][29] This variety presents significant challenges to the clinician and histopathologist as many cases show a bland appearance, mimicking a scar (paucicellular or pure variant). In addition, the tumor cells of the mixed DM variant are characterized by areas of high-cell density with fascicular or sheet-like growth with no or only minimal intervening fibrous stroma.…”

“…13,14,[19][20][21][22][23][24]30 DM diagnosis can be particularly problematic in small biopsy specimens, a difficulty complicated by an atypical immunoprofile. [18][19][20][21][22][23][24]29 Here, we describe the clinicopathologic features of 3 cases of cutaneous DM with histological features initially misinterpreted as cutaneous MPNST or benign neural tumor.…”