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Pure desmoplastic melanoma: a melanoma with distinctive clinical behavior Maurichi A; Miceli R; Camerini T; Contiero P; Patuzzo R; Tragni G; Crippa F; Romanidis K; Ruggeri R; Carbone A; Santinami MAnn Surg 2010[Dec]; 252 (6): 1052-7OBJECTIVE: 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 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); 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.|Aged[MESH]|Female[MESH]|Fibrosis[MESH]|Humans[MESH]|Male[MESH]|Melanoma/mortality/*pathology/surgery[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local/*pathology[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Skin Neoplasms/mortality/*pathology/surgery[MESH]|Survival Analysis[MESH] |
