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Published on: August 19, 2021
Desmoplastic melanoma: a 12-year experience with sentinel lymph node biopsy
P N Broer1, M E Walker, C Goldberg
1Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, USA.
Summary
Desmoplastic melanoma (DM) shows a higher incidence of nodal metastasis than previously reported, with 18% of patients having positive sentinel lymph node biopsy (SLNB) results. SLNB is recommended for both pure and mixed DM subtypes due to these findings.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma.
- Data on nodal involvement in DM is limited, impacting clinical management guidelines.
- Sentinel lymph node biopsy (SLNB) is a key staging procedure for melanoma.
Purpose of the Study:
- To determine the incidence of nodal metastasis in patients with desmoplastic melanoma.
- To inform guidelines for performing SLNB in desmoplastic melanoma.
- To compare nodal metastasis rates between pure and mixed DM subtypes.
Main Methods:
- Retrospective review of a prospectively maintained database from 1998-2010.
- Identification of 24 patients diagnosed with desmoplastic melanoma (0.7% of 3531 melanoma cases).
- Analysis of clinical and histological parameters, SLNB results, and patient outcomes.
Main Results:
- Of 22 patients who underwent SLNB, 4 (18%) had micro-metastases.
- Patients with mixed DM had a higher rate of nodal metastasis (25%) compared to pure DM (14%).
- Follow-up revealed local recurrence (9%), in-transit recurrence (9%), and distant metastases (27%).
Conclusions:
- The observed incidence of nodal metastasis in DM (14% pure, 25% mixed) is higher than previously reported.
- These findings support the continued recommendation for SLNB in patients with both pure and mixed desmoplastic melanoma.
- SLNB aids in accurate staging and guides further treatment decisions for DM patients.
