Skip to main content
Erschienen in: Annals of Surgical Oncology 7/2013

01.07.2013 | Melanomas

Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?

verfasst von: Dale Han, MD, Jonathan S. Zager, MD, Daohai Yu, PhD, Xiuhua Zhao, MS, Brooke Walls, DO, Suroosh S. Marzban, MS, Nikhil G. Rao, MD, Vernon K. Sondak, MD, Jane L. Messina, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The utility of sentinel lymph node biopsy (SLNB) for desmoplastic melanoma (DM) is debated. We describe a large single-institution experience with SLNB for DM to determine clinicopathologic factors predictive of SLN metastasis.

Methods

Retrospective review identified 205 patients with DM who underwent SLNB from 1992 to 2010. Clinicopathologic characteristics were correlated with SLN status and outcome.

Results

Median age was 66 years, and 69 % of patients were male. Median Breslow thickness was 3.7 mm. In 128 cases (62 %), histologic subtype data was available; 61 cases (47.7 %) were mixed and 67 cases (52.3 %) were pure DM. A positive SLN was found in 28 cases (13.7 %); 24.6 % of mixed and 9 % of pure DM had SLN metastases. Multivariable analysis demonstrated that after controlling for age, histologic subtype correlated with SLN status [odds ratio: 3.0 for mixed vs pure, 95 % confidence interval: 1.1–8.7; p < .05]. Completion lymph node dissection was performed in 24 of 28 positive SLN patients with 16.7 % of cases having additional nodal disease. After a median follow-up of 6.3 years, 38 patients developed recurrence and 61 patients died. Positive SLN patients had a significantly higher risk of melanoma-related death compared with negative SLN patients (p = .01).

Conclusions

The overall risk for SLN metastasis for DM is 13.7 % and is significantly higher for mixed (24.6 %) compared with pure (9.0 %) DM. We believe that these rates are sufficient to justify consideration of SLNB for both histologic variants, especially since detection of SLN disease appears to predict a higher risk for melanoma-related death.
Literatur
1.
Zurück zum Zitat Quinn MJ, Crotty KA, Thompson JF, Coates AS, O’Brien CJ, McCarthy WH. Desmoplastic and desmoplastic neurotropic melanoma: experience with 280 patients. Cancer. 1998;83:1128–35.PubMedCrossRef Quinn MJ, Crotty KA, Thompson JF, Coates AS, O’Brien CJ, McCarthy WH. Desmoplastic and desmoplastic neurotropic melanoma: experience with 280 patients. Cancer. 1998;83:1128–35.PubMedCrossRef
3.
Zurück zum Zitat Feng Z, Wu X, Chen V, Velie E, Zhang Z. Incidence and survival of desmoplastic melanoma in the United States, 1992–2007. J Cutan Pathol. 2011;38:616–24.PubMedCrossRef Feng Z, Wu X, Chen V, Velie E, Zhang Z. Incidence and survival of desmoplastic melanoma in the United States, 1992–2007. J Cutan Pathol. 2011;38:616–24.PubMedCrossRef
4.
Zurück zum Zitat Busam KJ, Mujumdar U, Hummer AJ, Nobrega J, Hawkins WG, Coit DG, et al. Cutaneous desmoplastic melanoma: reappraisal of morphologic heterogeneity and prognostic factors. Am J Surg Pathol. 2004;28:1518–25.PubMedCrossRef Busam KJ, Mujumdar U, Hummer AJ, Nobrega J, Hawkins WG, Coit DG, et al. Cutaneous desmoplastic melanoma: reappraisal of morphologic heterogeneity and prognostic factors. Am J Surg Pathol. 2004;28:1518–25.PubMedCrossRef
5.
Zurück zum Zitat Jaroszewski DE, Pockaj BA, DiCaudo DJ, Bite U. The clinical behavior of desmoplastic melanoma. Am J Surg. 2001;182:590–5.PubMedCrossRef Jaroszewski DE, Pockaj BA, DiCaudo DJ, Bite U. The clinical behavior of desmoplastic melanoma. Am J Surg. 2001;182:590–5.PubMedCrossRef
6.
Zurück zum Zitat Livestro DP, Muzikansky A, Kaine EM, Flotte TJ, Sober AJ, Mihm MC Jr, et al. Biology of desmoplastic melanoma: a case-control comparison with other melanomas. J Clin Oncol. 2005;23:6739–46.PubMedCrossRef Livestro DP, Muzikansky A, Kaine EM, Flotte TJ, Sober AJ, Mihm MC Jr, et al. Biology of desmoplastic melanoma: a case-control comparison with other melanomas. J Clin Oncol. 2005;23:6739–46.PubMedCrossRef
7.
Zurück zum Zitat Hawkins WG, Busam KJ, Ben-Porat L, Panageas KS, Coit DG, Gyorki DE, et al. Desmoplastic melanoma: a pathologically and clinically distinct form of cutaneous melanoma. Ann Surg Oncol. 2005;12:207–13.PubMedCrossRef Hawkins WG, Busam KJ, Ben-Porat L, Panageas KS, Coit DG, Gyorki DE, et al. Desmoplastic melanoma: a pathologically and clinically distinct form of cutaneous melanoma. Ann Surg Oncol. 2005;12:207–13.PubMedCrossRef
8.
Zurück zum Zitat Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, et al. Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer. 2006;106:900–6.PubMedCrossRef Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, et al. Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer. 2006;106:900–6.PubMedCrossRef
9.
Zurück zum Zitat Davison JM, Rosenbaum E, Barrett TL, Goldenberg D, Hoque MO, Sidransky D, et al. Absence of V599E BRAF mutations in desmoplastic melanomas. Cancer. 2005;103:788–92.PubMedCrossRef Davison JM, Rosenbaum E, Barrett TL, Goldenberg D, Hoque MO, Sidransky D, et al. Absence of V599E BRAF mutations in desmoplastic melanomas. Cancer. 2005;103:788–92.PubMedCrossRef
10.
Zurück zum Zitat Su LD, Fullen DR, Lowe L, Wang TS, Schwartz JL, Cimmino VM, et al. Desmoplastic and neurotropic melanoma. Cancer. 2004;100:598–604.PubMedCrossRef Su LD, Fullen DR, Lowe L, Wang TS, Schwartz JL, Cimmino VM, et al. Desmoplastic and neurotropic melanoma. Cancer. 2004;100:598–604.PubMedCrossRef
11.
Zurück zum Zitat Posther KE, Selim MA, Mosca PJ, Stanley WE, Johnson JL, Tyler DS, et al. Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma. Ann Surg Oncol. 2006;13:728–39.PubMedCrossRef Posther KE, Selim MA, Mosca PJ, Stanley WE, Johnson JL, Tyler DS, et al. Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma. Ann Surg Oncol. 2006;13:728–39.PubMedCrossRef
12.
Zurück zum Zitat Gyorki DE, Busam K, Panageas K, Brady MS, Coit DG. Sentinel lymph node biopsy for patients with cutaneous desmoplastic melanoma. Ann Surg Oncol. 2003;10:403–7.PubMedCrossRef Gyorki DE, Busam K, Panageas K, Brady MS, Coit DG. Sentinel lymph node biopsy for patients with cutaneous desmoplastic melanoma. Ann Surg Oncol. 2003;10:403–7.PubMedCrossRef
13.
Zurück zum Zitat Wasif N, Gray RJ, Pockaj BA. Desmoplastic melanoma—the step-child in the melanoma family? J Surg Oncol. 2011;103:158–62.PubMedCrossRef Wasif N, Gray RJ, Pockaj BA. Desmoplastic melanoma—the step-child in the melanoma family? J Surg Oncol. 2011;103:158–62.PubMedCrossRef
14.
Zurück zum Zitat Thelmo MC, Sagebiel RW, Treseler PA, Morita ET, Nguyen LH, Kashani-Sabet M, et al. Evaluation of sentinel lymph node status in spindle cell melanomas. J Am Acad Dermatol. 2001;44:451–5.PubMedCrossRef Thelmo MC, Sagebiel RW, Treseler PA, Morita ET, Nguyen LH, Kashani-Sabet M, et al. Evaluation of sentinel lymph node status in spindle cell melanomas. J Am Acad Dermatol. 2001;44:451–5.PubMedCrossRef
15.
Zurück zum Zitat Murali R, Shaw HM, Lai K, McCarthy SW, Quinn MJ, Stretch JR, et al. Prognostic factors in cutaneous desmoplastic melanoma: a study of 252 patients. Cancer. 2010;116:4130–8.PubMedCrossRef Murali R, Shaw HM, Lai K, McCarthy SW, Quinn MJ, Stretch JR, et al. Prognostic factors in cutaneous desmoplastic melanoma: a study of 252 patients. Cancer. 2010;116:4130–8.PubMedCrossRef
16.
Zurück zum Zitat Mohebati A, Ganly I, Busam KJ, Coit D, Kraus DH, Shah JP, et al. The role of sentinel lymph node biopsy in the management of head and neck desmoplastic melanoma. Ann Surg Oncol. 2012;19:4307–13.PubMedCrossRef Mohebati A, Ganly I, Busam KJ, Coit D, Kraus DH, Shah JP, et al. The role of sentinel lymph node biopsy in the management of head and neck desmoplastic melanoma. Ann Surg Oncol. 2012;19:4307–13.PubMedCrossRef
17.
Zurück zum Zitat George E, McClain SE, Slingluff CL, Polissar NL, Patterson JW. Subclassification of desmoplastic melanoma: pure and mixed variants have significantly different capacities for lymph node metastasis. J Cutan Pathol. 2009;36:425–32.PubMedCrossRef George E, McClain SE, Slingluff CL, Polissar NL, Patterson JW. Subclassification of desmoplastic melanoma: pure and mixed variants have significantly different capacities for lymph node metastasis. J Cutan Pathol. 2009;36:425–32.PubMedCrossRef
18.
Zurück zum Zitat NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Melanoma, version 1.2013. National Comprehensive Cancer Network, Fort Washington, PA. Available at: www.NCCN.org, 2013. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Melanoma, version 1.2013. National Comprehensive Cancer Network, Fort Washington, PA. Available at: www.​NCCN.​org, 2013.
19.
Zurück zum Zitat Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline. Ann Surg Oncol. 2012;19:3313–24.PubMedCrossRef Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline. Ann Surg Oncol. 2012;19:3313–24.PubMedCrossRef
20.
Zurück zum Zitat Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline. J Clin Oncol. 2012;30:2912–8.PubMedCrossRef Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline. J Clin Oncol. 2012;30:2912–8.PubMedCrossRef
21.
Zurück zum Zitat Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedCrossRef Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedCrossRef
22.
Zurück zum Zitat Ross MI, Reintgen D, Balch CM. Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol. 1993;9:219–23.PubMed Ross MI, Reintgen D, Balch CM. Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma. Semin Surg Oncol. 1993;9:219–23.PubMed
23.
Zurück zum Zitat Carlson JA, Dickersin GR, Sober AJ, Barnhill RL. Desmoplastic neurotropic melanoma. A clinicopathologic analysis of 28 cases. Cancer. 1995;75:478–94.PubMedCrossRef Carlson JA, Dickersin GR, Sober AJ, Barnhill RL. Desmoplastic neurotropic melanoma. A clinicopathologic analysis of 28 cases. Cancer. 1995;75:478–94.PubMedCrossRef
24.
Zurück zum Zitat Payne WG, Kearney R, Wells K, Blue M, Walusimbi M, Mosiello G, et al. Desmoplastic melanoma. Am Surg. 2001;67:1004–6.PubMed Payne WG, Kearney R, Wells K, Blue M, Walusimbi M, Mosiello G, et al. Desmoplastic melanoma. Am Surg. 2001;67:1004–6.PubMed
25.
Zurück zum Zitat Smithers BM, McLeod GR, Little JH. Desmoplastic melanoma: patterns of recurrence. World J Surg. 1992;16:186–90.PubMedCrossRef Smithers BM, McLeod GR, Little JH. Desmoplastic melanoma: patterns of recurrence. World J Surg. 1992;16:186–90.PubMedCrossRef
26.
Zurück zum Zitat Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or =4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–5.PubMedCrossRef Gershenwald JE, Mansfield PF, Lee JE, Ross MI. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or =4 mm) primary melanoma. Ann Surg Oncol. 2000;7:160–5.PubMedCrossRef
27.
Zurück zum Zitat Scoggins CR, Bowen AL, Martin RC, 2nd, Edwards MJ, Reintgen DS, Ross MI, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145:622–7.PubMedCrossRef Scoggins CR, Bowen AL, Martin RC, 2nd, Edwards MJ, Reintgen DS, Ross MI, et al. Prognostic information from sentinel lymph node biopsy in patients with thick melanoma. Arch Surg. 2010;145:622–7.PubMedCrossRef
28.
Zurück zum Zitat Cherpelis BS, Haddad F, Messina J, Cantor AB, Fitzmorris K, Reintgen DS, et al. Sentinel lymph node micrometastasis and other histologic factors that predict outcome in patients with thicker melanomas. J Am Acad Dermatol. 2001;44:762–6.PubMedCrossRef Cherpelis BS, Haddad F, Messina J, Cantor AB, Fitzmorris K, Reintgen DS, et al. Sentinel lymph node micrometastasis and other histologic factors that predict outcome in patients with thicker melanomas. J Am Acad Dermatol. 2001;44:762–6.PubMedCrossRef
29.
Zurück zum Zitat Gajdos C, Griffith KA, Wong SL, Johnson TM, Chang AE, Cimmino VM, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115:5752–60.PubMedCrossRef Gajdos C, Griffith KA, Wong SL, Johnson TM, Chang AE, Cimmino VM, et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009;115:5752–60.PubMedCrossRef
30.
Zurück zum Zitat Murali R, Zannino D, Synnott M, McCarthy SW, Thompson JF, Scolyer RA. Clinical and pathological features of metastases of primary cutaneous desmoplastic melanoma. Histopathology. 2011;58:886–95.PubMedCrossRef Murali R, Zannino D, Synnott M, McCarthy SW, Thompson JF, Scolyer RA. Clinical and pathological features of metastases of primary cutaneous desmoplastic melanoma. Histopathology. 2011;58:886–95.PubMedCrossRef
31.
Zurück zum Zitat Scoggins CR, Martin RC, Ross MI, Edwards MJ, Reintgen DS, Urist MM, et al. Factors associated with false-negative sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol. 2010;17:709–17.PubMedCrossRef Scoggins CR, Martin RC, Ross MI, Edwards MJ, Reintgen DS, Urist MM, et al. Factors associated with false-negative sentinel lymph node biopsy in melanoma patients. Ann Surg Oncol. 2010;17:709–17.PubMedCrossRef
32.
Zurück zum Zitat Tanis PJ, Nieweg OE, van den Brekel MW, Balm AJ. Dilemma of clinically node-negative head and neck melanoma: outcome of “watch and wait” policy, elective lymph node dissection, and sentinel node biopsy—a systematic review. Head Neck. 2008;30:380–9.PubMedCrossRef Tanis PJ, Nieweg OE, van den Brekel MW, Balm AJ. Dilemma of clinically node-negative head and neck melanoma: outcome of “watch and wait” policy, elective lymph node dissection, and sentinel node biopsy—a systematic review. Head Neck. 2008;30:380–9.PubMedCrossRef
33.
Zurück zum Zitat Martin RC, Shannon KF, Quinn MJ, Saw RP, Spillane AJ, Stretch JR, et al. The management of cervical lymph nodes in patients with cutaneous melanoma. Ann Surg Oncol. 2012;19:3926–32.PubMedCrossRef Martin RC, Shannon KF, Quinn MJ, Saw RP, Spillane AJ, Stretch JR, et al. The management of cervical lymph nodes in patients with cutaneous melanoma. Ann Surg Oncol. 2012;19:3926–32.PubMedCrossRef
34.
Zurück zum Zitat Erman AB, Collar RM, Griffith KA, Lowe L, Sabel MS, Bichakjian CK, et al. Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. Cancer. 2012;118:1040–7.PubMedCrossRef Erman AB, Collar RM, Griffith KA, Lowe L, Sabel MS, Bichakjian CK, et al. Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma. Cancer. 2012;118:1040–7.PubMedCrossRef
35.
Zurück zum Zitat Parrett BM, Kashani-Sabet M, Singer MI, Li R, Thummala S, Fadaki N, et al. Long-term prognosis and significance of the sentinel lymph node in head and neck melanoma. Otolaryngol Head Neck Surg. 2012;147:699–706.PubMedCrossRef Parrett BM, Kashani-Sabet M, Singer MI, Li R, Thummala S, Fadaki N, et al. Long-term prognosis and significance of the sentinel lymph node in head and neck melanoma. Otolaryngol Head Neck Surg. 2012;147:699–706.PubMedCrossRef
36.
Zurück zum Zitat Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRef Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRef
37.
Zurück zum Zitat Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10:676–80.PubMedCrossRef Wrightson WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10:676–80.PubMedCrossRef
38.
Zurück zum Zitat Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel-node biopsy in primary melanoma. Nat Clin Pract Oncol. 2008;5:510–1.PubMedCrossRef Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel-node biopsy in primary melanoma. Nat Clin Pract Oncol. 2008;5:510–1.PubMedCrossRef
Metadaten
Titel
Desmoplastic Melanoma: Is There a Role for Sentinel Lymph Node Biopsy?
verfasst von
Dale Han, MD
Jonathan S. Zager, MD
Daohai Yu, PhD
Xiuhua Zhao, MS
Brooke Walls, DO
Suroosh S. Marzban, MS
Nikhil G. Rao, MD
Vernon K. Sondak, MD
Jane L. Messina, MD
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 7/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2883-z

Weitere Artikel der Ausgabe 7/2013

Annals of Surgical Oncology 7/2013 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.