Critical appraisal:Posther KE, Selim MA, Mosca PJ, Stanley WE, Johnson JL, Tyler DS, et al 2006

Critical Appraisal

Article being appraised

Posther KE, Selim MA, Mosca PJ, Stanley WE, Johnson JL, Tyler DS, et al. Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma. Ann Surg Oncol 2006 May;13(5):728-39 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16538415.

Applicable clinical question

What is the optimal management for primary desmoplastic neurotropic melanomas?

Key Facts

Study Design

cohort study

Study aims:

To examine disease characteristics, recurrence patterns, nodal metastases, and correlation with survival to provide additional guidance for the surgical management of primary and recurrent Desmoplastic Melanoma (DM)

Number of Patients:

129

129 patients with DM out of >12,500 melanoma patients referred for treatment from 1980 to 2003 at the Duke Comprehensive Cancer Centre.
In this study, DM was pathologically defined as loosely arranged, atypical spindle cells invading the dermis; staining for S-100 and HMB-45, neurotropic features, and the presence or absence of pigmentation also contributed to diagnosis.

Reported outcome(s):

Median time to recurrence
Overall Survival (OS)
Disease Free Survival (DFS)

Results of outcome(s):

- 51 patients (39.5%) experienced disease recurrence
- Median time to recurrence: 1.3 years

Types of recurrences:
- Local first recurrence: 18 patients (14%); median time to recurrence: 1 years; median survival: 6.7 yrs
- Nodal (regional nodes) first recurrence: 18 patients (14%); median time to recurrence: 1.3 years; median survival: 7.8 yrs
- Distant first recurrence: 15 patients (11.6%); median time to recurrence: 1.7 years; median survival: 1.8 yrs

For all DM patients:
OS: 90% at 2 years, 76% at 5 years, 64% at 10 years
Median OS: 13 years
DFS: 71% at 2 years, 55% at 5 years
Median DFS: 6.4 years
- 24 Deaths were attributed to DM: 5 died with lung metastases, 4 with liver metastases, 3 with bony metastases, 1 with gastrointestinal involvement, 7 with multiorgan involvement and 4 with unknown site of distant metastasis.

In time to event analyses, age > or equal to 60 years, AJCC stage, Breslow thickness >4.00 mm, and Clark level V were all predictive of decreased OS & decreased DFS

Includes an economic evaluation

no