World Journal of Surgery

, Volume 16, Issue 2, pp 186–190 | Cite as

Desmoplastic melanoma: Patterns of recurrence

  • B. Mark Smithers
  • G. Roderick McLeod
  • John H. Little
World Progress In Surgery

Abstract

Desmoplastic melanoma is a rare type of malignant melanoma, recognized since 1971. Other variants of desmoplastic melanoma include neural transforming melanoma and neurotropic melanoma.

The pathology and clinical features of 58 patients whose tumor had the features of desmoplastic melanoma, neural transforming melanoma, and neurotropic melanoma, either separately or in combination, were examined to assess patterns of recurrent disease. The tumor was situated on the head and neck in 41% of patients and was amelanotic in 71% of patients. There was an associated superficial melanoma in 48% of patients. There was a combination of the 3 histologic patterns, commonly found in the 1 melanoma. Local recurrence occurred in 29% of patients and malignant cranial neuropathies were documented in 4 patients. Nineteen percent of patients have died from disseminated disease. Neurotropic melanomas had a lower incidence of visceral recurrence. Desmoplastic and neural transforming melanomas had similar rates of local and visceral recurrence.

When this specific variant of melanoma is compared with larger series of malignant melanoma in general, they appear to be more advanced locally, with a higher incidence of local recurrence. When considered in relation to the thicker nondesmoplastic melanomas, the survival is no worse and may be more favorable.

Surgeons should excise the primary tumor and local recurrences with wide margins and adopt close follow-up. On the head and neck, symptoms and signs relating to trigeminal or facial nerve innervation may herald a developing malignant cranial neuropathy.

Résumé

Le mélanome desmoplastique est une forme rare de mélanome malin, reonnu depuis 1971. D'autres variantes de mélanome malin desmoplastique sont des mélanomes neuraux et neurotropiques. Les caractéristiques anatomopathologiques et cliniques de 58 patients ayant un mélanome malin desmoplastique, neural ou neurotropique, observées séparément ou conjointement, ont été analysées pour évaluer les facteurs de récidive. La tumeur était localisée à la tête ou au cou chez 41% des patients et était amélanique chez 71% des patients. Le mélanome était superficiel chez 48% des patients. Les trois types histologiques étaient souvent présents. Une récidive locale a été observée chez 29% des patients. Une neuropathie maligne crânienne a été documentée chez 4 patients. Dix neuf pour cent des patients sont morts de maladie disséminée. L'incidence de récidive viscérale était plus faible chez les patients ayant un mélanome neurotropique. Les taux de récidive, locale et viscérale, des mélanomes neuraux et desmoplastiques étaient similaires. Lorsqu'on compare cette variété de mélanome à de plus grandes séries de mélanomes en général, ils semblent avoir un stade local plus évolué avec un taux de récidive locale plus élevé. La survie des patients atteints de ces tumeurs, comparée à celle des cas de tumeurs non desmoplastiques plus épaisses, est similaire, voire meileure. La tumeur primitive et les récidives doivent être exercisées avec des marges larges. La surveillance doit être rigoureuse. Lorsque le mélanome est situé au niveau de la tête ou du cou, la préscence de signes et symptômes dans les territoires des nerfs trijumeau ou facial, peut annoncer une atteinte nerveuse maligne.

Resumen

El melanoma desmoplásico es un tipo raro de melanoma maligno, reconocido desce 1971; otras variaciones de melanoma desmoplásico incluyen et melanoma de trasnformación neural y el melanoma neurotrópico.

Las características patológicas y clínicas de 58 pacientes cuyos tumores poseían las características de melanoma desmoplásico, de melanoma de trasnformación neural y de melanoma neurotrópico, bien en forma separada o en forma combinada, fueron analizadas para determinar los patrones de enfermedad recurrente. El tumor apareció ubicado en la cabeza y cuello en 41% de los casos y amelanótico en 71%; se observó melanoma superficial asociado en 48% de los pacientes. Existió la combinación de los 3 patrones histológicos comunmente hallados en este tipo de melanoma. La recurrencia local se presentó en 29% de los pacientes y neuropatías craneanas malignas fueron documentados en 4 pacientes; 19% de los pacientes murieron por enfermedad diseminada. Los melanomas neurotrópicos exhibieron una menor incidencia de recurrencia visceral. Los melanomas desmoplásicos y de transformación neural exhibieron tasas similares de recurrencia local y visceral.

Cuando esta variante específica de melanoma es comparada con grandes series de melanomas generales, aparece más avanzado localmente y con mayor incidencia de recurrencia local. Cuando se lo considera en relación con los espesos melanomas no desmoplásicos, la sobrevida no aparece peor, y tal vez más favorable.

Los cirujanos deben resecar el tumpor primario y las recurrencias locales con amplios márgenes y adoptar un estricto regimen de seguimiento. En el caso de los tumores de la cabeza y el cuello, los síntomas y signos relacionados con la inervación del trigémino o del facial pueden anunciar el desarrollo de una neuropatía craneana.

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Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • B. Mark Smithers
    • 1
  • G. Roderick McLeod
    • 1
  • John H. Little
    • 1
  1. 1.Princess Alexandra Hospital, Queensland Melanoma Project, and Department of SurgeryUniversity of QueenslandBrisbaneAustralia

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