Risk of Recurrence with Desmoplastic Melanoma and Desmoplastic Neurotropic Melanoma (DNM)

  • Historically, local recurrence with desmoplastic neurotropic melanoma (DNM):
    • Has been high
  • In a retrospective analysis of 280 patients with DNM and desmoplastic melanoma:
    • Quinn et al found:
      • A significantly greater local recurrence rate:
        • Associated with margins of less than 1 cm compared with margins greater than 2 cm (P=0.001):
          • No significant benefit was found when excision margins of 1 to 2 cm and greater than 2 cm were compared:
            • Although the odds ratio for recurrence was 2:1 for the group with 1- to 2-cm margins compared with the group with greater than 2-cm margins
    • Chen et al:
      • Noted a 6% crude local recurrence rate in their surgery-alone group:
        • This excellent local control rate was achieved despite 27.7% of the tumors having a mitotic rate of 5 or more, 14.9% of tumors being ulcerated, and 40.5% of tumors having a Breslow depth greater than 4 mm
  • In the series reported by Chen et al:
    • Four patients had DNM involving named nerves
    • All patients received adjuvant RT:
      • Covering the primary excision site and the involved nerve and its route to the base of the skull
    • Local control was achieved in these patients, although one patient died of metastatic disease
    • RT is important for these patients:
      • As recurrence extending beyond the base of the skull may not be surgically salvageable
  • Strom et al:
    • Analyzed 277 patients with desmoplastic melanoma:
      • Of whom 113 (40.8%) received RT
    • They found two subsets of patients who seemed to gain no benefit from RT:
      • These groups were those with:
        • Negative resection margins
        • A non-head and neck tumor location
        • A Breslow thickness of ≤ 4 mm
        • No perineural invasion
      • A patient with a head and neck tumor location with perineural invasion (PNI):
        • RT would be indicated based on these data
  • Guadagnolo et al:
    • Analyzed 130 patients with desmoplastic melanoma:
      • Of whom 55% received adjuvant RT
    • Although local control was not found to be significantly different among those with PNI versus those without:
      • 81% vs 88%, respectively; P=.52:
        • When local control outcomes were stratified by receipt of postoperative RT:
          • Patients with PNI who received RT had significantly better local control than those who did not:
            • 91% vs 63% at 10 years, respectively; P=.02
          • For those patients who clearly did not have PNI:
            • RT did not significantly improve local control:
              • 90% with RT vs 85% without RT at 10 years; P=.82
  • References:
    • Chen JY, Hruby G, Scolyer RA, et al. Desmoplastic neurotropic melanoma: a clinicopathologic analysis of 128 cases. Cancer. 2008;113:2770-2778.
    • Guadagnolo BA, Prieto V, Weber R, et al. The role of adjuvant radiotherapy in the local management of desmoplastic melanoma. Cancer.2014;120:1361-1368
    • Quinn MJ, Crotty KA, Thompson JF, Coates AS, O’Brien CJ, McCarthy WH. Desmoplastic and desmoplastic neurotropic melanoma: experience with 280 patients. Cancer. 1998;83:1128-1135.
    • Strom T, Caudell JJ, Han D, et al. Radiotherapy influences local control in patients with desmoplastic melanoma. Cancer. 2014;120:1369-1378.

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