Critical appraisal:Chen JY, Hruby G, Scolyer RA, Murali R, Hong A, Fitzgerald P, et al 2008

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Critical Appraisal

Article being appraised

Chen JY, Hruby G, Scolyer RA, Murali R, Hong A, Fitzgerald P, et al. Desmoplastic neurotropic melanoma: a clinicopathologic analysis of 128 cases. Cancer 2008 Nov 15;113(10):2770-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18823042.


Applicable clinical question

Key Facts

Study Design

cohort study

Study aims:

To describe the clinicopathologic features of desmoplastic neurotropic melanoma, to update outcomes, and to explore the role of adjuvant radiation treatment in the management of this entity.

Number of Patients:

128

local excision alone: 101

local excision plus adjuvant radiotherapy: 27

MARGINS:
</= 1 mm: 13 pts
1.1 mm to 5 mm: 25 pts
5.1 to 9.9 mm: 36 pts
>1 cm: 41 pts

positive: 8 pts
Reported outcome(s):

local recurrence
in-transit metastases
lymph node metastases
distant metastases

Results of outcome(s):

LOCAL RECURRENCE
4.9% vs 1.6%, p=NR; surgery alone vs surgery plus radiotherapy

IN TRANSIT METASTASES
78.9% vs NA, p=NA; surgery alone vs surgery plus radiotherapy

LYMPH NODE METASTASES
11.7% vs 3.9%, p=NR; surgery alone vs surgery plus radiotherapy

DISTANT METASTASES
13.3% vs 2.3%; surgery alone vs surgery plus radiotherapy

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
High risk of bias Comments: selection not described, baseline not comparable and not adjusted for, objective measures used, all patients accounted for

Risk of bias assessment: cohort study

Subject selection
"New technology" group
Highly selected or not described
Comparison group
Selected group
Comparability of groups on demographic characteristics and clinical features
Not comparable and not adjusted for differences
Measurement of outcomes
Outcome measures blind to technology used
No, but objective measures used
Same method of measurement used across comparison groups
Yes
Completeness of follow-up
Was follow-up complete and were all patients included in the analysis?
Yes (follow-up >95%) or survival analysis using all patients
Size of effect
5 Reason for decision: Please replace this text and briefly describe the reasons for your rating
Relevance of evidence
1 Additional comments: Please replace this text and briefly describe the reasons for your rating
Result of appraisal

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Completed by

Cecilia Taing


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Article
Chen JY, Hruby G, Scolyer RA, Murali R, Hong A, Fitzgerald P, et al. Desmoplastic neurotropic melanoma: a clinicopathologic analysis of 128 cases. Cancer 2008 Nov 15;113(10):2770-8 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18823042.
Assigned to
User:Cecilia.taing
Topic area
Guidelines:Melanoma
Clinical question
Form
Form:Critical appraisal


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