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
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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
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