Wide excision without radiation for desmoplastic melanoma

Area of Science:

• Dermatology
• Surgical Oncology
• Melanoma Research

Background:

• Desmoplastic melanoma has historically high local recurrence rates (40-60%) after treatment.
• Adjuvant radiation therapy has been proposed to manage this risk.
• This study evaluates the efficacy of wide excision alone for desmoplastic melanoma.

Purpose of the Study:

• To determine local recurrence rates in desmoplastic melanoma patients treated with wide excision alone.
• To assess the effectiveness of surgical management without adjuvant radiation.

Main Methods:

• Retrospective review of 65 patients with pure cutaneous desmoplastic melanoma (March 1997-March 2004).
• Data collected included surgical, histopathologic, staging information, and outcomes (recurrence, survival).
• All patients underwent wide excision; adjuvant radiation was not used.

Main Results:

• The study cohort had a 2:1 male-to-female ratio, mean age 65, and 55% of tumors on the head and neck.
• Mean Breslow depth was 4.21 mm; 38% were >4.0 mm thick.
• With a median follow-up of 3.7 years (49 patients), the local recurrence rate was 4% (2/49), and 78% had no evidence of disease.

Conclusions:

• Local recurrence rates in this series were significantly lower than historically reported rates for desmoplastic melanoma.
• Wide local excision with appropriate margins provides excellent local control.
• Adjuvant radiation therapy may not be necessary for desmoplastic melanoma when treated with adequate surgical margins.