Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma

PLOS ONE, Dec 2019

Background and Objectives Desmoplastic melanoma is a unique subtype of melanoma which typically affects older patients who often have comorbidities that can adversely affect survival. We sought to identify melanoma-specific factors influencing survival in patients with desmoplastic melanoma. Methods Retrospective review from 1993 to 2011 identified 316 patients with primary desmoplastic melanoma. Clinicopathologic characteristics were correlated with nodal status and outcome. Results Fifty-five patients (17.4%) had nodal disease: 33 had a positive sentinel lymph node biopsy and 22 developed nodal recurrences (no sentinel lymph node biopsy or false-negative sentinel lymph node biopsy). Nodal disease occurred more often in younger patients and in cases with mixed compared with pure histology (26.7% vs. 14.6%); both of these variables significantly predicted nodal status on multivariable analysis (p<0.05). After a median follow-up of 5.3 years, recurrence developed in 87 patients (27.5%), and 111 deaths occurred. The cause of death was known in 79 cases, with 47 deaths (59.5%) being melanoma-related. On multivariable analysis, Breslow thickness, mitotic rate ≥1/mm2 and nodal status significantly predicted melanoma-specific survival (p<0.05). Conclusions Nodal status predicts melanoma-specific survival in patients with desmoplastic melanoma. However, since patients with desmoplastic melanoma represent an older population, and a considerable proportion of deaths are not melanoma-related (40.5%), comorbidities should be carefully considered in making staging and treatment decisions in this population.

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Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma

March Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma Dale Han 0 1 2 Gang Han 0 1 2 Xiuhua Zhao 0 1 2 Nikhil G. Rao 0 1 2 Jane L. Messina 0 1 2 Suroosh S. Marzban 0 1 2 Amod A. Sarnaik 0 1 2 C. Wayne Cruse 0 1 2 Vernon K. Sondak 0 1 2 Jonathan S. Zager 0 1 2 0 1 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States of America, 2 Department of Biostatistics, Yale University School of Public Health , New Haven , Connecticut, United States of America, 3 Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida, United States of America, 4 Department of Radiation Oncology, Florida Hospital , Orlando , Florida, United States of America, 5 Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, United States of America, 6 Departments of Pathology and Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, Florida, United States of America, 7 Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine , Tampa, Florida , United States of America 1 Data Availability Statement: All relevant data are within the paper 2 Academic Editor: Andrzej T Slominski, University of Tennessee, UNITED STATES - Competing Interests: The authors of this manuscript have the following competing interests: VKS Consultant/Advisory Board: Merck, Navidea (Neoprobe); JLMConsultant: Glaxo Smith Kline, Consultant: Myriad Corporation. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. Background and Objectives Desmoplastic melanoma is a unique subtype of melanoma which typically affects older patients who often have comorbidities that can adversely affect survival. We sought to identify melanoma-specific factors influencing survival in patients with desmoplastic melanoma. Retrospective review from 1993 to 2011 identified 316 patients with primary desmoplastic melanoma. Clinicopathologic characteristics were correlated with nodal status and Fifty-five patients (17.4%) had nodal disease: 33 had a positive sentinel lymph node biopsy and 22 developed nodal recurrences (no sentinel lymph node biopsy or false-negative sentinel lymph node biopsy). Nodal disease occurred more often in younger patients and in cases with mixed compared with pure histology (26.7% vs. 14.6%); both of these variables significantly predicted nodal status on multivariable analysis (p<0.05). After a median follow-up of 5.3 years, recurrence developed in 87 patients (27.5%), and 111 deaths occurred. The cause of death was known in 79 cases, with 47 deaths (59.5%) being melanoma-related. On multivariable analysis, Breslow thickness, mitotic rate nificantly predicted melanoma-specific survival (p<0.05). 1/mm2 and nodal status sigNodal status predicts melanoma-specific survival in patients with desmoplastic melanoma. However, since patients with desmoplastic melanoma represent an older population, and a considerable proportion of deaths are not melanoma-related (40.5%), comorbidities should be carefully considered in making staging and treatment decisions in this population. Desmoplastic melanoma (DM) is characterized by malignant spindled melanocytes within an abundant collagenous/myxoid (desmoplastic) stroma and is classically divided into histologic pure and mixed subtypes based on the extent of desmoplasia [13]. DM represents <4% of all primary cutaneous melanomas and was first reported by Conley et al., who described a melanoma variant with a relatively high potential for recurrence and aggressive clinical behavior [1, 46]. In that initial study of 7 DM patients, 3 developed nodal metastases (42.9%) and 4 (57.1%) died from DM [6]. Later studies indicated that DM most commonly develops on the head and neck of older males and often presents as a thicker tumor compared with conventional or non-desmoplastic melanoma [13, 5, 711]. In contrast to the initial findings of Conley et al., subsequent studies have not reported the high rates of nodal metastasis and melanoma-related death for DM patients [1, 2, 48, 1013]. The true rates of nodal metastasis and melanoma-related mortality from DM, however, remain undefined. Recently reported nodal metastasis rates for DM range from 0 to 18.8%, with most studies describing lower nodal metastasis rates for DM compared with non-DM cases. In particular, pure DM cases exhibit a lower rate of nodal metastasis despite greater median tumor thickness [720]. Some studies suggest that survival for DM patients is similar to or better than what is observed for non-DM patients and that histologic subtype may influence survival [15, 8, 10, 12, 13]. The inconsistent reports on factors influencing nodal involvement and survival in DM patients make it difficult to assess prognosis and optimize staging and treatment of this disease. This is further complicated by the fact that DM typically affects older patients who often have c (...truncated)


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Dale Han, Gang Han, Xiuhua Zhao, Nikhil G. Rao, Jane L. Messina, Suroosh S. Marzban, Amod A. Sarnaik, C. Wayne Cruse, Vernon K. Sondak, Jonathan S. Zager. Clinicopathologic Predictors of Survival in Patients with Desmoplastic Melanoma, PLOS ONE, 2015, Volume 10, Issue 3, DOI: 10.1371/journal.pone.0119716