Desmoplastic malignant melanoma: a systematic review

Lens, Marko; Newton-Bishop, Julia; Boon, A. P.

doi:10.1111/j.1365-2133.2005.06462.x

Cited by 142 publications

(152 citation statements)

References 29 publications

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“…Head and neck locations are the most common sites for development of primary desmoplastic melanoma, ranging from 52 to 72% of all locations. 22,33 Also of interest is the observation that in desmoplastic melanomas that have an associated intra-epidermal component, the majority exhibit a lentigo maligna-like phenotype (56 of 91 cases, 61% in one series; 22 ), with generally small, monomorphous melanocytes in a lentiginous growth pattern and minimal pagetoid scatter. 22,34,35 This also suggests homology with other melanomas on chronically sun-damaged skin, which commonly exhibit c-KIT mutations.…”

Section: Discussionmentioning

confidence: 99%

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

et al. 2012

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Desmoplastic melanoma is subclassified into pure and mixed variants with a higher rate of lymph node metastasis in the latter. Given that reasons for these biological differences are not currently known, we investigated these subtypes with techniques that included genetic and immunohistochemical analyses of 43 cases of desmoplastic melanoma (24 pure, 19 mixed). Direct DNA sequencing was performed on BRAFV600E, RET gene (coding region on exon 11) and KIT (exons 11, 13 and 17). Immunohistochemical stains were performed with antibodies to markers of significance with respect to biological potential of nevomelanocytic proliferations and/or desmoplastic melanoma (Ki-67, CD117, nestin, clusterin, SOX10 and CD271/p75NTR). Polymorphism at the RET coding region (RETp) was noted in 33% of pure (8/24 cases) versus 24% of mixed (4/17 cases); BRAFV600E was absent in all cases of pure (0/24 cases) versus 6% of mixed (1/17 cases); no mutations were found in any of the cases on analyses of exons 11, 13 and 17 of the c-KIT gene (P ¼ NS for all). For immunohistochemical analyses of pure versus mixed: mean percentage of Ki-67 nuclear positivity was 5% (s.d. ¼ 5.6) versus 28% (s.d. ¼ 12.6, Po0.001); CD117 stained 26% (6/23 cases) versus 78% (14/18 cases, Po0.01); nestin stained 83% (n ¼ 19/23 cases) versus 89% (16/18 cases, P ¼ NS); clusterin stained 4% (1/23 cases) versus 6% (1/18 cases, P ¼ NS); SOX10 87% (20/23 cases) versus 94% (17/18 cases, P ¼ NS) and CD271 stained 61% (14/23 cases) versus 67% (12/18 cases, P ¼ NS). Increased CD117 staining in the mixed variant suggests that alterations in the KIT protein may be involved in tumor progression. In addition, the proliferative index of the mixed variant was higher than that of the pure variant.

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Section: Discussionmentioning

confidence: 99%

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

et al. 2012

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“…4,25,26 When comparing case-matched controls, in which the incidence was 20%, the overall incidence was 12% in Livestro's cohort of 89 DMs (including 50 DNMs). 21 The lower incidence of lymph node metastasis suggests a different biology and natural history for DM compared with conventional melanoma, 27 in which thicker tumors were more likely to be associated with regional lymph node involvement. Approximately 8% of patients in the current study presented with positive regional lymph nodes, which was higher than the 4% to 5% in the cohorts reported by Quinn et al and Livestro et al, reflecting the thicker tumors in our series.…”

Section: Regional Lymph Node Involvementmentioning

confidence: 99%

Desmoplastic neurotropic melanoma

Chen

Hruby

Scolyer

et al. 2008

Cancer

127

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BACKGROUND.Several studies have suggested that desmoplastic neurotropic melanoma (DNM) is associated with higher local recurrence rates than other types of melanoma. The authors investigated the local recurrence rates for patients with DNM after surgery alone or surgery followed by radiotherapy (RT).METHODS.One hundred twenty‐eight patients with DNM were treated at the Sydney Melanoma Unit and the Sydney Cancer Center from 1996 to 2007. All patients underwent local excision, 27 patients also received RT. For both groups, clinical and pathologic features, treatment details, and local recurrence data were analyzed.RESULTS.The median age at diagnosis was 65.5 years. The ratio of men to women was 2.7:1. The head and neck was the most common location (51%). The median Breslow thickness was 4 mm, and 99% of patients had Clark Level IV or V primary tumors. Patients who received adjuvant RT had thicker tumors (P = .003), deeper Clark level invasion (P < .001), and narrower excision margins (P < .001). There were 8 local recurrences, including 6 (6%) in the surgery only group and 2 (7%) in the adjuvant RT group. A positive margin (P < .001) and head and neck location (P = .03) were significant predictors of local recurrence.CONCLUSIONS.The local recurrence rate in this series was lower than the rates reported in historic control groups and in the authors' previous temporal cohort. The results indicated that clear surgical margins are of paramount importance in minimizing local recurrence; when margins are compromised, the addition of RT may reduce local recurrence rates compared with historic controls. A prospective randomized trial is needed to quantify the risk reduction with adjuvant RT. Cancer 2008. © 2008 American Cancer Society.

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“…[2][3][4][5] There is an ongoing debate whether sentinel lymph node biopsy should be performed in desmoplastic melanoma because its metastatic rate is somewhat lower when compared with conventional melanoma and spindle cell melanoma. [6][7][8][9][10][11][12] The overall prognosis in desmoplastic melanoma tends to be better when compared stage by stage with conventional melanoma. 9,13 In contrast, spindle cell melanoma is frequently amelanotic, can occur essentially anywhere on the body, and presents typically with widespread metastatic disease.…”

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confidence: 99%

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

et al. 2014

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Spindle cell melanoma and desmoplastic melanoma differ clinically in prognosis and therapeutic implications; however, because of partially overlapping histopathological features, diagnostic distinction of spindle cell from desmoplastic melanoma is not always straightforward. A direct comparison of diagnostic and therapeutic biomarkers has not been performed. Meta-review of the literature discloses key clinicopathological differences between spindle cell and desmoplastic melanoma, including immunophenotypes. Using 50 biomarkers available in routine diagnostics, we examined 38 archival cases (n ¼ 16 spindle, 18 desmoplastic, 4 mixed spindle/desmoplastic melanoma). S100 remains as the most reliable routine marker to reach the diagnosis of melanoma in spindle cell and desmoplastic melanoma. We identified nine distinctly labeling markers with spindle cell melanoma showing positivity for laminin, p75, HMB45, c-kit, and MelanA, and desmoplastic melanoma preferentially labeling with collagen IV, trichrome, CD68, and MDM2. On the basis of comparisons of test performance measures, MelanA and trichrome were used to devise a 94% sensitive diagnostic algorithm for the distinction of desmoplastic from spindle cell melanoma. Gene amplification and expression status was assessed for a set of potentially drugable targets (HER2, EGFR, MET, MDM2, TP53, ALK, MYC, FLI-1, and KIT). Fluorescent in situ hybridizations did not reveal a significant number of gene aberrations/rearrangements; however, protein overexpression for at least one of these markers was identified in 35 of 38 cases (92%). In addition, we found BRAF mutations in 31% of spindle cell and 5% of desmoplastic melanoma, with an overall mutation frequency of 16% (n ¼ 6/38). We present the first comprehensive screening study of diagnostic and therapeutic biomarkers in spindle cell and desmoplastic melanoma. The devised algorithm allows diagnostic distinction of desmoplastic from spindle cell melanoma when routine histology is not decisive.

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Desmoplastic malignant melanoma: a systematic review

Abstract: Prompt definitive surgical excision is the treatment of choice for DM. Improved knowledge of the clinical behaviour and histological features of DM is important for more effective management of patients with DM.

Cited by 142 publications

References 29 publications

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

Mixed versus pure variants of desmoplastic melanoma: a genetic and immunohistochemical appraisal

Desmoplastic neurotropic melanoma

A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma

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