OBJECTIVE: The purpose of the study was to evaluate the excision margin necessary for desmoplastic melanoma (DM). BACKGROUND: DM consists of 2 histologic subtypes, pure DM (PDM) and mixed DM (MDM), differing in extent of fibrotic component. We investigated clinical and therapeutic determinants of prognosis in these DM entities. METHODS: We reviewed 118 PDM and 124 MDM treated at our Institute over 25 years. Local relapse, distant metastasis, and survival were studied. RESULTS: Most (91.7%) distant metastases in PDM developed after 1 or more local recurrences; whereas distant metastasis usually (79.6%) occurred as first event in MDM. Overall mortality trends in relation to lesion-thickness-plus-excision-width differed for PDM (P = 0.014) but not MDM (P = 0.185). For PDM, 5-year crude cumulative incidence (CCI) of mortality was higher (40.0%) for thin tumors (≤ 2 mm thick) excised with 1 cm margin than those excised with 2 cm (14.8%); CCI of mortality for PDM > 2 mm thick excised with 2 cm margins (13.4%) was similar to that for thin PDM lesions excised with 2 cm (14.8%). CCI of local recurrence was also greater in PDM excised with 1 cm margins. In MDM, mortality increased with stage but was independent of excision width (CCI: 29.4% for ≤ 2 mm/2 cm, 31.3% for ≤ 2 mm/1 cm, and 48.3% for > 2 mm/2 cm); a similar trend was found for MDM distant metastases. CONCLUSIONS: In PDM, limited excision width is associated with significantly greater local recurrence and mortality; treatment should be excision with 2 cm margins even for thin lesions. MDM behaves similarly to other melanomas; treatment should follow guidelines on melanoma management.
OBJECTIVE: The purpose of the study was to evaluate the excision margin necessary for desmoplastic melanoma (DM). BACKGROUND:DM consists of 2 histologic subtypes, pure DM (PDM) and mixed DM (MDM), differing in extent of fibrotic component. We investigated clinical and therapeutic determinants of prognosis in these DM entities. METHODS: We reviewed 118 PDM and 124 MDM treated at our Institute over 25 years. Local relapse, distant metastasis, and survival were studied. RESULTS: Most (91.7%) distant metastases in PDM developed after 1 or more local recurrences; whereas distant metastasis usually (79.6%) occurred as first event in MDM. Overall mortality trends in relation to lesion-thickness-plus-excision-width differed for PDM (P = 0.014) but not MDM (P = 0.185). For PDM, 5-year crude cumulative incidence (CCI) of mortality was higher (40.0%) for thin tumors (≤ 2 mm thick) excised with 1 cm margin than those excised with 2 cm (14.8%); CCI of mortality for PDM > 2 mm thick excised with 2 cm margins (13.4%) was similar to that for thin PDM lesions excised with 2 cm (14.8%). CCI of local recurrence was also greater in PDM excised with 1 cm margins. In MDM, mortality increased with stage but was independent of excision width (CCI: 29.4% for ≤ 2 mm/2 cm, 31.3% for ≤ 2 mm/1 cm, and 48.3% for > 2 mm/2 cm); a similar trend was found for MDM distant metastases. CONCLUSIONS: In PDM, limited excision width is associated with significantly greater local recurrence and mortality; treatment should be excision with 2 cm margins even for thin lesions. MDM behaves similarly to other melanomas; treatment should follow guidelines on melanoma management.
Authors: Lucy L Chen; Natalia Jaimes; Christopher A Barker; Klaus J Busam; Ashfaq A Marghoob Journal: J Am Acad Dermatol Date: 2012-12-23 Impact factor: 11.527
Authors: Tobin Strom; Jimmy J Caudell; Dale Han; Jonathan S Zager; Daohai Yu; C Wayne Cruse; Suroosh S Marzban; Jane L Messina; Andy M Trotti; Vernon K Sondak; Nikhil G Rao Journal: Cancer Date: 2013-10-18 Impact factor: 6.860
Authors: Sherman Chu; Kory P Schrom; Raghav Tripathi; Rosalynn R Z Conic; Harib H Ezaldein; Jeffrey F Scott; Kord Honda Journal: Am J Dermatopathol Date: 2021-11-01 Impact factor: 1.319
Authors: 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 Journal: PLoS One Date: 2015-03-26 Impact factor: 3.240