Previous studies have established that patients with desmoplastic melanoma (DM) have thicker primary tumors. Consequently, comparisons with other forms of melanoma have been strongly biased by differences in Breslow stage. This is the first case-matched control study comparing DM with other forms of melanoma.
From a database of 3,202 melanoma patients treated at one institution, 89 patients with DM and 178 case-matched control patients (2:1) were identified by matching for tumor thickness, age, sex, and year of diagnosis. Clinical, pathologic, and outcome information was obtained from chart review.
Controls were matched successfully to patients for tumor thickness, age, sex, and year of diagnosis. Presentation with American Joint Committee on Cancer stage III or IV disease is less common in patients with DM compared to case-matched control patients (5% v 21%; P < .001). Re-excisions to obtain clear surgical margins are required more often in patients with DM compared to case-matched control patients (21% v 6%; P < .001). Risk of positive sentinel nodes is lower in patients with DM compared to case-matched control patients (8% v 34%; P = .013). Despite these differences, survival rates of patients with DM are the same as case-matched control patients.
Use of case-matched control patients matched for tumor thickness avoids biases introduced by the advanced Breslow stage of DMs. DMs are more locally aggressive than thickness-matched controls, and positive sentinel nodes are limited to patients with thick primary tumors. Importantly, patients with DM have survival rates similar to patients with other melanomas of similar thickness.
"We found that patients with thick desmoplastic melanomas were less likely to undergo SLNB. It is possible that SLNB was less commonly offered in these patients because desmoplastic melanomas have been shown to have lower rates of sentinel lymph node metastasis . Additionally, desmoplastic melanomas are more common on the head/neck, and these areas may be more challenging for lymphatic mapping and SLNB may therefore be deferred in favor of clinical observation. "
[Show abstract][Hide abstract] ABSTRACT: Background. Sentinel lymph node biopsy (SLNB) for thick cutaneous melanoma is supported by national guidelines. We report on factors associated with the use and underuse of SLNB for thick primary cutaneous melanoma. Methods. The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for thick primary cutaneous melanoma from 2004 to 2008. We used multivariate logistic regression models to predict use of SLNB. Results. Among 1,981 patients, 833 (41.8%) did not undergo SLNB. Patients with primary melanomas of the arm (OR 2.07, CI 1.56-2.75; P < 0.001), leg (OR 2.40, CI 1.70-3.40; P < 0.001), and trunk (OR 1.82, CI 1.38-2.40; P < 0.001) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11-1.96; P = 0.008). A decreased likelihood of receiving SLNB was noted for advancing age ≥ 60 years (age 60 to 69: OR 0.58, CI 0.33-0.99, P = 0.047; age 70 to 79: OR 0.32, CI 0.19-0.54, P < 0.001; age 80 or more: OR 0.10, CI 0.06-0.16, P < 0.001) and unknown race/ethnicity (OR 0.21, CI 0.07-0.62; P = 0.005). Conclusions. In particular, elderly patients are less likely to receive SLNB. Further research is needed to assess whether use of SLNB in this population is detrimental or beneficial.
"For example, some studies have shown that desmoplastic melanoma has a better prognosis than other variants , with some researchers concluding that this type of melanoma is significantly and independently associated with a shorter time of recurrence . However, this finding has been called into question by other groups . "
[Show abstract][Hide abstract] ABSTRACT: Researchers have searched for factors that predict the metastatic potential of melanomas for decades. In recent years, the study of their metastatic potential has progressed from routine histological analysis of Hematoxylin-Eosin stained slides to proteomic, genetic, and molecular pathological analyses. As a result, knowledge about the metastatic potential of melanomas has progressed. Hundreds of prognostic factors have been described in literature and it is not possible to mention all of them in a report. Therefore, in the current report, we summarize some of them.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 09/2012; 53(3):449-59. · 0.66 Impact Factor
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