Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

• Published in: Cancer Vol. 106; no. 4; pp. 900 - 906
• Main Authors: Pawlik, Timothy M., Ross, Merrick I., Prieto, Victor G., Ballo, Matthew T., Johnson, Marcella M., Mansfield, Paul F., Lee, Jeffrey E., Cormier, Janice N., Gershenwald, Jeffrey E.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.02.2006; Wiley-Liss
• Subjects: Biological and medical sciences; desmoplastic melanoma; Female; Follow-Up Studies; Humans; Lymphatic Metastasis - diagnosis; Male; Medical sciences; Melanoma - pathology; Melanoma - therapy; Middle Aged; Neoplasm Staging - methods; Patient Care Planning; Retrospective Studies; Sentinel Lymph Node Biopsy; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Skin Ulcer - etiology; Skin Ulcer - pathology; Tumors; Anatomic pathology; sentinel lymph node biopsy; Cancerology; Biopsy; Sentinel lymph node; Primary; Desmoplastic melanoma; Skin
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21635

BACKGROUND The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as ‘pure’ DM or ‘mixed’ DM (i.e., DM associated with at least one other common histologic subtype). RESULTS Of the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non‐DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non‐DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (each P < 0.01 vs. non‐DM and mixed DM). At a median follow‐up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non‐DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted. Cancer 2006. © 2006 American Cancer Society. The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The authors report that patients with a pure DM histologic subtype have a lower incidence of positive SLNs compared with patients who have mixed DM or non‐DM melanomas. Whereas patients with mixed DM should be treated like all other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.