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10.1245/ASO.2006.03.091
Annals of Surgical Oncology 13:728-739 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Histopathologic Characteristics, Recurrence Patterns, and Survival of 129 Patients With Desmoplastic Melanoma

Katherine E. Posther, MD1, M. Angelica Selim, MD2, Paul J. Mosca, MD, PhD3, Wilma E. Stanley, BS4, Jeffrey L. Johnson, MS3, Douglas S. Tyler, MD1 and Hilliard F Seigler, MD1

1 Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
2 Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710
3 Lehigh Valley Hospital and Health Network, 1240 S. Cedar Crest Boulevard, Allentown, Pennsylvania 18103
4 Duke Comprehensive Cancer Center, Duke University Medical Center, Durham, North Carolina 27710

Correspondence: Address correspondence and reprint requests to: Katherine E. Posther, MD; E-mail: posth001{at}yahoo.com.

Background: Desmoplastic melanoma (DM) has been associated with higher local recurrence rates than other types of cutaneous melanoma. Current controversies regarding loco-regional treatment strategies warrant further investigation.

Methods: Retrospective review of a prospectively maintained melanoma database identified 129 patients with DM out of >12,500 melanoma patients referred for treatment from 1980 to 2003. Clinical and histopathologic characteristics, recurrence, and survival were analyzed.

Results: The median follow-up was 4.0 years. Of the 129 patients identified, 82 (63.6%) were male, and the median age was 55.2 years. American Joint Committee on Cancer staging was I, II, and III in 25.6%, 68.0%, and 6.4% of patients, respectively, and the mean tumor thickness was 4.42 mm. Overall survival was 76% at 5 years and 64% at 10 years; median survival was 13.0 years. A total of 51 patients (39.5%) experienced disease recurrence, with a median time to recurrence of 1.3 years. The first recurrence was local in 18 patients (14.0%), nodal in 18 patients (14.0%), and distant in 15 patients (11.6%), with median survivals of 6.7, 7.8, and 1.8 years, respectively. Statistically significant predictors of recurrence were a final positive margin status and stage, and predictors of overall survival were patient age and stage.

Conclusions: Compared with other types of melanoma, DMs do demonstrate a tendency toward local recurrence, thus suggesting that narrower excision margins may not be appropriate in this population. Scrutiny of final surgical margins is critical to the local management of DM. In addition, the potential for regional nodal involvement must be considered at the time of diagnosis and during surveillance for disease recurrence.

Key Words: Desmoplastic • Melanoma • Histopathology • Recurrence • Survival






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