Desmoplastic melanoma: Is there a role for sentinel lymph node biopsy?

Dale Han, Jonathan S. Zager, Daohai Yu, Xiuhua Zhao, Brooke Walls, Suroosh S. Marzban, Nikhil G. Rao, Vernon K. Sondak, Jane L. Messina

Research output: Contribution to journalReview article

29 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2345-2351
Number of pages7
JournalAnnals of surgical oncology
Volume20
Issue number7
DOIs
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    Han, D., Zager, J. S., Yu, D., Zhao, X., Walls, B., Marzban, S. S., Rao, N. G., Sondak, V. K., & Messina, J. L. (2013). Desmoplastic melanoma: Is there a role for sentinel lymph node biopsy? Annals of surgical oncology, 20(7), 2345-2351. https://doi.org/10.1245/s10434-013-2883-z