Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

Timothy M. Pawlik, Merrick I. Ross, Victor G. Prieto, Matthew Ballo, Marcella M. Johnson, Paul F. Mansfield, Jeffrey E. Lee, Janice N. Cormier, Jeffrey E. Gershenwald

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Abstract

BACKGROUND. The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS. In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as 'pure' DM or 'mixed' DM (i.e., DM associated with at least one other common histologic subtype). RESULTS. Of the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non-DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non-DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (each P < 0.01 vs. non-DM and mixed DM). At a median follow-up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS. Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non-DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.

Original languageEnglish (US)
Pages (from-to)900-906
Number of pages7
JournalCancer
Volume106
Issue number4
DOIs
StatePublished - Feb 15 2006

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Sentinel Lymph Node Biopsy
Melanoma
Skin

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Pawlik, T. M., Ross, M. I., Prieto, V. G., Ballo, M., Johnson, M. M., Mansfield, P. F., ... Gershenwald, J. E. (2006). Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer, 106(4), 900-906. https://doi.org/10.1002/cncr.21635

Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. / Pawlik, Timothy M.; Ross, Merrick I.; Prieto, Victor G.; Ballo, Matthew; Johnson, Marcella M.; Mansfield, Paul F.; Lee, Jeffrey E.; Cormier, Janice N.; Gershenwald, Jeffrey E.

In: Cancer, Vol. 106, No. 4, 15.02.2006, p. 900-906.

Research output: Contribution to journalArticle

Pawlik, TM, Ross, MI, Prieto, VG, Ballo, M, Johnson, MM, Mansfield, PF, Lee, JE, Cormier, JN & Gershenwald, JE 2006, 'Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma', Cancer, vol. 106, no. 4, pp. 900-906. https://doi.org/10.1002/cncr.21635
Pawlik, Timothy M. ; Ross, Merrick I. ; Prieto, Victor G. ; Ballo, Matthew ; Johnson, Marcella M. ; Mansfield, Paul F. ; Lee, Jeffrey E. ; Cormier, Janice N. ; Gershenwald, Jeffrey E. / Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. In: Cancer. 2006 ; Vol. 106, No. 4. pp. 900-906.
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title = "Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma",
abstract = "BACKGROUND. The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS. In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as 'pure' DM or 'mixed' DM (i.e., DM associated with at least one other common histologic subtype). RESULTS. Of the 1850 patients, 65 (3.5{\%}) had DM. Of these, 46 (70.8{\%}) had pure DM and 19 (29.2{\%}) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5{\%} were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non-DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7{\%} and 21.3{\%}, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8{\%}) and non-DM (17.5{\%}), patients with pure DM were less likely to have a positive SLN (2.2{\%}) (each P < 0.01 vs. non-DM and mixed DM). At a median follow-up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS. Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non-DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.",
author = "Pawlik, {Timothy M.} and Ross, {Merrick I.} and Prieto, {Victor G.} and Matthew Ballo and Johnson, {Marcella M.} and Mansfield, {Paul F.} and Lee, {Jeffrey E.} and Cormier, {Janice N.} and Gershenwald, {Jeffrey E.}",
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T1 - Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

AU - Pawlik, Timothy M.

AU - Ross, Merrick I.

AU - Prieto, Victor G.

AU - Ballo, Matthew

AU - Johnson, Marcella M.

AU - Mansfield, Paul F.

AU - Lee, Jeffrey E.

AU - Cormier, Janice N.

AU - Gershenwald, Jeffrey E.

PY - 2006/2/15

Y1 - 2006/2/15

N2 - BACKGROUND. The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS. In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as 'pure' DM or 'mixed' DM (i.e., DM associated with at least one other common histologic subtype). RESULTS. Of the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non-DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non-DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (each P < 0.01 vs. non-DM and mixed DM). At a median follow-up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS. Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non-DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.

AB - BACKGROUND. The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS. In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as 'pure' DM or 'mixed' DM (i.e., DM associated with at least one other common histologic subtype). RESULTS. Of the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non-DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non-DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (each P < 0.01 vs. non-DM and mixed DM). At a median follow-up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS. Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non-DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.

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