Pure Desmoplastic Melanoma

Maurichi, Andrea; Miceli, Rosalba; Camerini, Tiziana; Contiero, Paolo; Patuzzo, Roberto; Tragni, Gabrina; Crippa, Federica; Romanidis, Κonstantinos; Ruggeri, Roberta; Carbone, Antonino; Santinami, Mario

doi:10.1097/sla.0b013e3181efc23c

Cited by 53 publications

(19 citation statements)

References 25 publications

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“…Positive resection margins have previously been shown to be associated with increased rates of local recurrence with desmoplastic melanoma. 4,5,10,11,16 In this series, there was a striking (40%) absolute reduction in local recurrence among patients with positive resection margins who received RT (3 of 22 patients; 14%) compared with those who did not (7 of 13 patients; 54%). To the best of our knowledge, this is among the strongest evidence to date supporting the use of adjuvant RT in patients with positive resection margins.…”

Section: Discussionmentioning

confidence: 65%

“…Most patients treated with RT in the current study had tumors with multiple adverse prognostic features, including a head and neck location, Breslow depth > 4 mm, and Clark level V. These factors have been repeatedly associated with worse local control, recurrence-free survival, and overall survival in patients with desmoplastic melanoma. 1,2,4,6–8,11,16,17 Because of the multiple adverse risk features in patients treated with RT, we performed a multivariable regression analysis to attempt to control for confounding factors with respect to local and locoregional control.…”

Section: Discussionmentioning

confidence: 99%

“…1,6–10,16,18 Positive resection margins placed patients at a higher risk of local recurrence than any other variable. Positive resection margins have previously been shown to be associated with increased rates of local recurrence with desmoplastic melanoma.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Radiotherapy influences local control in patients with desmoplastic melanoma

Ström

Caudell

Han

et al. 2013

Cancer

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“…1 Maurichi et al examined the differences in surgical margins between thin (<2mm) and thick (>2mm) pDM and mDM. 45 In patients with thin pDM, those with 1 cm margins had a higher rate of recurrence as well as worse 5-year OS compared to those treated with 2 cm margins (60% versus 85.2%, P=0.014). Thick pDM treated with 2 cm margins had similar survival to thin pDM treated with the same (86.6% versus 85.2%).…”

Section: Managementmentioning

confidence: 83%

Desmoplastic melanoma: A review

Chen

Jaimes

Barker

et al. 2013

Journal of the American Academy of Dermatology

156

171

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Desmoplastic melanoma (DM) is a variant of spindle cell melanoma typically found on chronically sun-damaged skin of older individuals. Early diagnosis can be challenging because it is often amelanotic and has a predominantly dermal component. DM can be difficult to diagnose not only clinically but also histologically, and can be mistaken for a variety of benign and malignant non-melanocytic spindle cell tumors when viewed on prepared histopathology slides. Pathologists have observed that DMs can manifest significant variation with respect to the extent of intratumoral cellularity, fibrosis and/or perineural invasion. Furthermore, some tumors present with a pure desmoplastic invasive component (>90%) while other tumors display mixed features of desmoplastic and non-desmoplastic melanoma. This has lead to the separation of DM into two histologic subtypes, pure and mixed. With a focus on the distinction between pure and mixed DM, this review will detail what is currently known about the diagnostic features of DM, discuss risk and prognostic factors and examine the current literature on disease progression and management.

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“…Both spindle cell and desmoplastic MM show atypical fusiform melanocytes, which are intermingled with dense and thickened collagen in desmoplastic MM. It is not a well-defined lesion; in fact malignant melanocytes infiltrate skin adnexa [12]. In spindle cell melanoma, melanocytes have elongated and hyperchromatic nuclei.…”

Section: Discussionmentioning

confidence: 99%

Bednar Tumour Occurring after Malignant Melanoma Excision

Ferlosio

Prete

Rossi

et al. 2018

Case Reports in Pathology

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We report the case of a seventy-four-year-old man with a slow-growing 2 cm mass on the back that arose near the surgical scar of previously excised melanoma, invasive to a Breslow depth of 3 mm. Preoperative clinical diagnosis was “in-transit” melanoma metastasis. After surgical excision, histopathologic examination revealed a dermal nodular proliferation of spindle cells arranged in storiform pattern, with mild pleomorphism, infiltrating around appendages and into the subcutaneous tissue. Immunohistochemical investigation documented diffuse positivity for CD34 and vimentin of spindle cells. Scattered dendritic cells, containing dark pigment in varying proportion and positive for S100, Melan-A and HMB-45, were also observed. A final diagnosis of Bednar tumour was formulated. Subsequently, the patient developed numerous metastases from the primary melanoma and died after 18 months. Bednar tumour is a rare pigmented variant of dermatofibrosarcoma protuberans of intermediate malignant potential. The presence of pigmented cells in Bednar tumour requires careful differential diagnosis with malignant or benign pigmented skin tumours. The clinical history of a Bednar tumour developing close to the scar of a previous melanoma gives the opportunity of a critical and intriguing discussion about the potential origin of pigmented cells in this rare variant of dermatofibrosarcoma protuberans.

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Pure Desmoplastic Melanoma

Abstract: In PDM, limited excision width is associated with significantly greater local recurrence and mortality; treatment should be excision with 2 cm margins even for thin lesions. MDM behaves similarly to other melanomas; treatment should follow guidelines on melanoma management.

Cited by 53 publications

References 25 publications

Radiotherapy influences local control in patients with desmoplastic melanoma

Radiotherapy influences local control in patients with desmoplastic melanoma

Desmoplastic melanoma: A review

Bednar Tumour Occurring after Malignant Melanoma Excision

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