Management of desmoplastic melanoma: a 20-year experience in a tertiary referral centre

Vonck, B. (Bernard) (2014) Management of desmoplastic melanoma: a 20-year experience in a tertiary referral centre. thesis, Medicine.

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Abstract

Background Desmoplastic melanoma(DesMel) is a relatively rare form of melanoma and accounts for less than 4% of all cutaneous melanomas. Although treatment protocols are similar for DesMel compared to other cutaneous melanomas, DesMel is known for its difference in clinical behaviour. The most important features of DesMel are the high rates of presentation without pigmentation and the occurrence on sun-damaged skin, especially in older patients. Furthermore, DesMel is associated with a higher local recurrence rate, lower rate of lymph nodal metastases and a better survival. However, most information is derived from small retrospective studies and there is no conclusive evidence on the optimal management of DesMel. Most importantly, the effects of local radiotherapy, size of surgical resection margins and the value of sentinel lymph node biopsy (SLNB) remain to be debated. Furthermore, there is no consensus on prognostic factors related to the incidence of local recurrence and survival. Aim The aim of this study was to evaluate the population of DesMel patients treated at the Antoni van Leeuwenhoek hospital(AvL). Secondly, we aimed to investigate prognostic factors related to local recurrence and survival in order to benefit the management of DesMel patients in the future. Methods This study was conducted at the AvL, a tertiary referral centre with an extensive experience in melanoma treatment. Over the period 1993-2013, 42 DesMel patients treated in the AvL were included in this study. Data was obtained on patient, tumour and management characteristics using patient files, pathology reports and surgery reports. Data including tumor location, Breslow thickness, Clark level, perineural invasion, surgical margins, SLNB and adjuvant radiotherapy was analysed and related to local recurrence rate and survival. Results Twenty-two patients were referred after diagnostic excision and underwent primary treatment in the AvL, the other 20 patient were referred after primary treatment in other hospitals. The mean Breslow thickness in this study cohort was relatively high (4,5 mm) and a relatively high number of tumours (26, 62%) occurred in the head and neck area. Sixteen patients(38%) underwent SLNB and a positive lymph node was found in one case. There were considerable amounts of missing values on tumour and management characteristics due to insufficient assessment and documentation of the pathology slides, and insufficient documentation on the management. Local recurrence occurred in 20 patients(48%), regional recurrence in 4 patients(10%) and distant recurrence in 8(19%). The 5 and 10 year overall survival(OS) was 64,5% and 50,7% respectively. The 5-year and 10-year disease specific survival(DSS) was 81,7% and 64,2% respectively. No characteristics as assessed in this study correlated with local recurrence. Patients treated with surgical resection margins of 2 cm had a significant better OS than smaller margins, and patients with a Breslow thickness over 4 mm had a significantly worse DSS compared to patients with a lower Breslow thickness. Conclusions Only 42 DesMel patients were treated in the AvL in a period of 20 years. There were considerable amounts of missing data which limited the value of our conclusions. The relatively high incidence of local recurrence(48%) is due to our inclusion of patients with recurrence after primary treatment in other hospitals. We could not demonstrate a correlation between prognostic factors investigated in our study and the incidence of local recurrence. We did demonstrate a better OS in patients treated with resection margins of 2 cm as compared to patients treated with smaller margins. In addition, a Breslow thickness over 4 cm was correlated with a worse DSS. This might imply that a more aggressive treatment for these tumours is in place.

Item Type:	Thesis (Thesis)
Supervisor name:	Dikkers, F.G.
Supervisor name:	Klop, W.M.C. and Balm, Prof. A.J.M. and Antoni van Leeuwenhoek hospital
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:41
Last Modified:	25 Jun 2020 10:41
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/277

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