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Ran NA, Veerabagu S, Miller CJ, Elenitsas R, Chu EY, Krausz AE. Local Recurrence Rates After Excision of Desmoplastic Melanoma: A Systematic Review and Meta-Analysis. Dermatol Surg 2023; 49:330-337. [PMID: 36857167 DOI: 10.1097/dss.0000000000003699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Few prospective studies have evaluated local recurrence rates (LRR) after excision of desmoplastic melanoma (DM); however, several retrospective studies have reported high LRR. OBJECTIVE To determine LRR after excision of DM and evaluate factors affecting LRR. MATERIALS AND METHODS Systematic review of the PubMed, Embase, and Web of Science databases was performed to identify studies reporting local recurrence after excision of DM with conventional wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision (SE). Meta-analysis was performed to calculate summary LRR and pooled risk ratios (RR). RESULTS Literature search identified 4 studies evaluating MMS or SE (total n = 61 DM). 53 studies assessed WLE ( n = 3,080) and were analyzed quantitatively. The overall LRR after WLE of DM was 21% (95% CI, 0.16-0.28; n = 2,308). Local recurrence rate was higher with positive/unknown histologic excision margins (49%, 95% CI, 0.25-0.74; n = 91) versus negative histologic margins (11%, 95% CI, 0.07-0.17; n = 1,075; [ p < .01]). Neurotropism was also associated with increased LRR (RR, 1.79; 95% CI, 1.34-2.38, p < .01; n = 644). CONCLUSION DM has high LRR after WLE. Local recurrence risk was greatest with positive excision margins, indicating the importance of achieving negative microscopic margins. Greater study of MMS and SE for DM is required.
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Affiliation(s)
- Nina A Ran
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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Stem cell properties in cell cultures from different stage of melanoma progression. Appl Immunohistochem Mol Morphol 2014; 22:171-81. [PMID: 23702651 DOI: 10.1097/pai.0b013e31828ff701] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma is an extremely heterogenous human cancer. The most aggressive melanoma may contain deregulated cells with undifferentiated/stem cell-like phenotype. A critical mechanism by which melanoma cells enhance their invasive capacity is the dissolution of the intercellular adhesion and the acquisition of mesenchymal features as a part of an epithelial-to-mesenchymal transition. The aim of this study was to clarify the role of a stem cell-like population in human melanomas by means of melanocytic cell culture analysis obtained from distinct histotypes of primary and metastatic malignant melanoma. Patients with advanced melanoma >2 cm in diameter and/or >300 mm surface were enrolled. The melanoma cells were isolated from skin biopsies of lentigo maligna melanoma, superficial spreading melanoma, nodular melanoma, and metastatic melanoma. The colony forming unit assay and alkaline phosphatase stain were evaluated. Cells were subsequently cultured and maintained in different media to evaluate their ability to differentiate into osteogenic and adipogenic lineages. Immunohistochemistry and flow cytometry analysis were performed to evaluate antigenic markers CD90, CD73, CD105, CD146, CD20, CD166, and Nestin. This study confirms that melanoma can include heterogenous cell populations with the ability both to self-renew and to a give rise to differentiated progeny. Melanoma cells displayed intratumoral heterogeneity and dynamic antigen phenotypes. Histologically, transitions from normal skin to melanoma were associated with a gradual increase in the expression of CD146, CD20, CD133, Nestin, and CD73. These molecular profiles could be further analyzed and, in the future, used for the development of novel biomolecular targeted-therapy approaches.
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Abstract
OBJECTIVE 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 1 cm margin than those excised with 2 cm (14.8%); CCI of mortality for PDM > 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, 31.3% for ≤ 2 mm/1 cm, and 48.3% 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.
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Abstract
Melanoma, one of the most aggressive forms of human cancer, has undergone an alarming increase in incidence in recent years. Early detection is a prerequisite for proper diagnosis and therapy orientation. Soluble biomarkers are an important tool for early diagnosis. Markers that are associated with melanocyte functions imply the enzymes involved in melanin synthesis and the melanin-related metabolites. Proteins such as autocrine melanocyte cell growth factor and melanoma metastasis suppressor have gained attention in the biomarkers domain. The antimelanoma immune response elicited in patients can not only provide new biomarkers but important therapeutic approaches in specific treatments. All the molecules generated during the metastasis process, invasion of neighboring tissue, angiogenesis, invading lymphatic/blood vessels and establishing new tumors at a distant site, are targets for biomarker discovery.
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Affiliation(s)
- Monica Neagu
- 'Victor Babes' National Institute of Pathology, Immunology Department, 99-101 Splaiul Independentei, 050096 Bucharest, Romania.
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Chen JY, Hruby G, Scolyer RA, Murali R, Hong A, Fitzgerald P, Pham TT, Quinn MJ, Thompson JF. Desmoplastic neurotropic melanoma: a clinicopathologic analysis of 128 cases. Cancer 2008; 113:2770-8. [PMID: 18823042 DOI: 10.1002/cncr.23895] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- James Y Chen
- Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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DiCaudo DJ, McCalmont TH, Wick MR. Selected Diagnostic Problems in Neoplastic Dermatopathology. Arch Pathol Lab Med 2007; 131:434-9. [PMID: 17516745 DOI: 10.5858/2007-131-434-sdpind] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Selected cutaneous neoplasms share features with benign counterparts or have subtle morphologic features that could be overlooked by the pathologist.
Objective.—To present clues to the diagnosis of potentially deceptive malignancies, including desmoplastic malignant melanoma, nevoid malignant melanoma, subcutaneous lymphoma, metastatic breast carcinoma, and epithelioid sarcoma.
Data Sources.—Published literature and personal experience.
Conclusions.—Knowledge of commonly misdiagnosed cutaneous neoplasms will help the general surgical pathologist avoid these potential pitfalls in neoplastic dermatopathology.
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Affiliation(s)
- David J DiCaudo
- Department of Dermatology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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Radfar A, Stefanato CM, Ghosn S, Bhawan J. NGFR-positive desmoplastic melanomas with focal or absent S-100 staining: Further evidence supporting the use of both NGFR and S-100 as a primary immunohistochemical panel for the diagnosis of desmoplastic melanomas. Am J Dermatopathol 2006; 28:162-7. [PMID: 16625082 DOI: 10.1097/01.dad.0000183696.46573.ee] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The histologic diagnosis of desmoplastic melanoma can be challenging in circumstances in which biopsy specimens are small, or there are unsuspected clinical settings, re-excision scars, and unusual sites. This is particularly true when the overlying junctional component is absent or the spindle cells lack melanin pigment. In these instances, the importance of immunohistochemistry cannot be overemphasized. S-100 protein is the primary immunohistochemical stain used for this purpose, with a sensitivity approaching 90%. HMB-45, although a more specific marker for melanocytes, is less sensitive and often negative in these cases. In addition, NGFR, a marker of Schwannian differentiation, has been shown to be a useful confirmatory stain for desmoplastic melanoma, with staining intensity comparable with, or better than that of S-100 protein. We report 2 cases of desmoplastic melanomas that stained only focally and weakly with S-100 protein, but showed diffuse and intense staining with NGFR. In both cases, S-100 staining could have been interpreted as non-confirmatory, thus misguiding the diagnosis. We suggest that NGFR can be a useful complementary marker to S-100 in those desmoplastic melanomas in which staining for S100 protein is only focal or weak.
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Affiliation(s)
- Arash Radfar
- Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Posther KE, Selim MA, Mosca PJ, Stanley WE, Johnson JL, Tyler DS, Seigler HF. Histopathologic Characteristics, Recurrence Patterns, and Survival of 129 Patients With Desmoplastic Melanoma. Ann Surg Oncol 2006; 13:728-39. [PMID: 16538415 DOI: 10.1245/aso.2006.03.091] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 10/12/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND Desmoplastic melanoma (DM) has been associated with higher local recurrence rates than other types of cutaneous melanoma. Current controversies regarding locoregional treatment strategies warrant further investigation. METHODS Retrospective review of a prospectively maintained melanoma database identified 129 patients with DM out of >12,500 melanoma patients referred for treatment from 1980 to 2003. Clinical and histopathologic characteristics, recurrence, and survival were analyzed. RESULTS The median follow-up was 4.0 years. Of the 129 patients identified, 82 (63.6%) were male, and the median age was 55.2 years. American Joint Committee on Cancer staging was I, II, and III in 25.6%, 68.0%, and 6.4% of patients, respectively, and the mean tumor thickness was 4.42 mm. Overall survival was 76% at 5 years and 64% at 10 years; median survival was 13.0 years. A total of 51 patients (39.5%) experienced disease recurrence, with a median time to recurrence of 1.3 years. The first recurrence was local in 18 patients (14.0%), nodal in 18 patients (14.0%), and distant in 15 patients (11.6%), with median survivals of 6.7, 7.8, and 1.8 years, respectively. Statistically significant predictors of recurrence were a final positive margin status and stage, and predictors of overall survival were patient age and stage. CONCLUSIONS Compared with other types of melanoma, DMs do demonstrate a tendency toward local recurrence, thus suggesting that narrower excision margins may not be appropriate in this population. Scrutiny of final surgical margins is critical to the local management of DM. In addition, the potential for regional nodal involvement must be considered at the time of diagnosis and during surveillance for disease recurrence.
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Affiliation(s)
- Katherine E Posther
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Hatori M, Watanabe M, Watanabe H, Hosaka M, Kokubun S. Desmoplastic melanoma arising in the ankle. Ups J Med Sci 2005; 110:251-8. [PMID: 16454164 DOI: 10.3109/2000-1967-072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Desmoplastic melanoma (DM) is an uncommon but potentially devastating malignancy that can be cured with early recognition and surgery. DM often occurs in elderly men and develops on sun-exposed areas with the head and neck being the most common site of origin followed by the extremities and trunk. We report a rare case of DM occurring in the ankle in an 85-year-old woman. Magnetic resonance imaging of the affected ankle showed a 4.3 x 4.3 x 2.5 cm sized mass which was located in the subcutaneous region, attached to lower leg muscles, the fibula, and the calcaneus. No metastasis to the lung, liver, bones or abdominal lymph nodes was found. In spite of below knee amputation, the patient died of lung metastases 10 months after surgery. Among several factors causing early death of the patient, a large size, a deep location and rapid growth of the tumor seem to be most important.
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Affiliation(s)
- Masahito Hatori
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Abstract
Desmoplastic melanoma (DM) is an uncommon type of spindle cell melanoma in which the malignant cells are separated by collagen fibres or fibrous stroma. DM is prone to misdiagnosis because of unfamiliarity with its often bland appearance and dissimilarity to other conventional types of melanoma. It displays variable cytological atypia, cellularity and stromal fibrosis and more often than not has an accompanying atypical junctional component. Neurotropism is a common associated feature (in at least 30% of cases) and when it occurs such tumours are termed 'desmoplastic neurotropic melanomas' (DNM). The neurotropism may be perineural or intraneural and often extends beyond the desmoplastic component. In addition, some DMs show evidence of neural differentiation ('neural transformation'). DM may also present as a recurrence or occasionally as a metastasis from other types of melanoma. A high index of suspicion and knowledge of its often subtle morphological appearance are necessary to avoid misdiagnosis.
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Affiliation(s)
- Stanley W McCarthy
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Robson A, Allen P, Hollowood K. S100 expression in cutaneous scars: a potential diagnostic pitfall in the diagnosis of desmoplastic melanoma. Histopathology 2001; 38:135-40. [PMID: 11207826 DOI: 10.1046/j.1365-2559.2001.01066.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The histological distinction of desmoplastic melanoma from cutaneous scar tissue, particularly in the context of re-excision specimens or possible recurrence, may be very difficult. Immunostaining for S100 protein is often used to discriminate although there are little data on S100 expression in scar tissue. The aim of this study was to assess whether S100-positive cells are present in dermal scars and, if so, their extent, distribution and nature. METHODS AND RESULTS Twenty-two re-excision specimens of previously biopsied nonmelanocytic skin lesions were reviewed. Formalin-fixed paraffin-embedded sections containing dermal scars were stained by a standard ABC immunoperoxidase technique for S100 protein, CD1a and neurofilaments. The distribution and morphology of positive cells within the dermal scar tissue were documented. Cells expressing S100 protein were identified within the scars of 21 of the 22 cases. The number of S100-positive cells varied between cases but in four specimens was substantial. They displayed a variety of morphological appearances but the majority were spindle-shaped. A few showed mild cytological atypia. It is suggested that the majority represent Schwann cells with a minority of Langerhans cells and cells of uncertain lineage. CONCLUSION S100-positive cells, including spindle cells showing mild atypia, are found in cutaneous scars. S100 staining of re-excision specimens or putative recurrences of desmoplastic melanoma should be interpreted with caution.
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Affiliation(s)
- A Robson
- Department of Cellular Pathology, Level 1, John Radcliffe Hospital, Headley Way, Oxford, UK
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