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

Han, Dale; Zager, Jonathan S.; Yu, Daohai; Zhao, Xiuhua; Walls, Brooke; Marzban, Suroosh S.; Rao, Nikhil G.; Sondak, Vernon K.; Messina, Jane L.

doi:10.1245/s10434-013-2883-z

Cited by 46 publications

(48 citation statements)

References 37 publications

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“…One study specifically examining thick melanomas and SLNB was performed by Gershenwald et al and reported a successful SLNB rate of 96%. The SLN positivity rate was 39% . As in intermediate and thin melanomas, patients with positive SLN are offered CLND of the affected lymph node basin, which is consistent with NCCN guidelines.…”

Section: Oncogenic Drivers Of Melanomasupporting

confidence: 63%

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Recent developments in the medical and surgical treatment of melanoma

Saranga-Perry

Ambe

Zager

et al. 2014

CA A Cancer J Clinicians

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Increasing knowledge of the biology of melanoma has led to significant advances in drug development to fight this disease. Surgery is the primary treatment for localized disease and is an integral part of management in patients with more advanced disease. The last decade has become the era of targeted therapy in melanoma and has revolutionized the treatment of this disease. Since 2011, 4 new agents have been approved for the treatment of patients with metastatic melanoma: ipilimumab, vemurafenib, dabrafenib, and trametinib. Several new agents are currently in phase 3 trials with hopes of even more agents being approved for this once "untreatable" disease. How to integrate surgical options with more effective systemic therapies has become a new challenge for physicians. This review will provide an update on current surgical options, highlight the pathway to the development of the newly approved agents, and further discuss new treatments that are on the horizon.

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Section: Oncogenic Drivers Of Melanomasupporting

confidence: 63%

“…The authors concluded that these rates are high enough to justify the use of SLNB in both variants of DM. 84 As such, at MCC we routinely offer SLNB to patients with DM. However, other major cancer centers do not perform SLNB in patients with DM.…”

Section: Desmoplastic Melanomamentioning

confidence: 99%

Recent developments in the medical and surgical treatment of melanoma

Saranga-Perry

Ambe

Zager

et al. 2014

CA A Cancer J Clinicians

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“…Because desmo-plastic melanoma spreads to the lymph nodes in only a minority of cases (12% in the current series and 14% in a previous analysis performed by our group among patients with desmoplastic melanoma who underwent sentinel lymph node biopsy 19 ), regional RT was rarely used. As a result, the role of local plus regional lymph node RT could not be adequately addressed.…”

Section: Discussionmentioning

confidence: 73%

Radiotherapy influences local control in patients with desmoplastic melanoma

Ström

Caudell

Han

et al. 2013

Cancer

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BACKGROUND Desmoplastic melanoma may have a high risk of local recurrence after wide excision. The authors hypothesized that adjuvant radiotherapy (RT) would improve local control in patients with desmoplastic melanoma, resulting in at least a 10% absolute decrease in local recurrence rate. METHODS A total of 277 patients from 1989 through 2010 who were treated for nonmetastatic desmoplastic melanoma by surgery with or without adjuvant RT were reviewed. Clinicopathologic and treatment variables were assessed with regard to their role in local control. RESULTS A total of 113 patients (40.8%) received adjuvant RT. After a median follow-up of 43.1 months, adjuvant RT was found to be independently associated with improved local control on multivariable analysis (hazards ratio, 0.15; 95% confidence interval, 0.06-0.39 [P <.001]). Among 35 patients with positive resection margins, 14% who received RT developed a local recurrence versus 54% who did not (P =.004). In patients with negative resection margins, there was a trend (P =.09) toward improved local control with RT. In patients with negative resection margins and traditionally high-risk features, including a head and neck tumor location, a Breslow depth > 4 mm, or a Clark level V tumor, RT was found to significantly improve local control (P <.05). The data from the current study would suggest that patients who would be good candidates for omitting RT included those with negative resection margins, a Breslow depth ≤4 mm, and either no perineural invasion present or a non-head and neck tumor location. CONCLUSIONS RT for desmoplastic melanoma was independently associated with improved local control. Patients with positive resection margins or deeper tumors appeared to benefit the most from RT, whereas selected low-risk patients can safely omit RT.

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“…The SLN procedure can be indicated, even though it is a rare situation and the bibliography is not so large (one investigator found positive SLNs in 9 % of patients) [46][47][48][49]. The incidence of lymph node metastases in patients with mixed-type desmoplastic melanoma appears to be the same as in those with non-desmoplastic melanoma [48].…”

Section: Indicationsmentioning

confidence: 99%