Cutaneous desmoplastic melanoma: Reappraisal of morphologic heterogeneity and prognostic factors Journal Article
| Authors: | Busam, K. J.; Mujumdar, U.; Hummer, A. J.; Nobrega, J.; Hawkins, W. G.; Coit, D. G.; Brady, M. S. |
| Article Title: | Cutaneous desmoplastic melanoma: Reappraisal of morphologic heterogeneity and prognostic factors |
| Abstract: | Desmoplastic melanoma (DM) is a variant of melanoma, which may be confused with nonmelanocytic benign or malignant spindle cell proliferations. The histologic hallmark of DM is the presence of fusiform melanocytes dispersed in a prominent collagenous stroma. Phenotypic heterogeneity of DM is underrecognized. Desmoplasia may be prominent throughout the entire tumor ("pure" DM) or represent a portion of an otherwise nondesmoplastic melanoma ("combined" DM). We reviewed melanomas with desmoplasia from 92 patients seen at a single institution between 1980 and 2002. Fifty-five of the tumors were pure DM. Thirty-seven were classified as combined. Mean follow-up of patients was 46 months for those alive at the last follow-up. Univariate analysis of clinical and pathologic parameters revealed four significant variables for disease-free survival: Clark level (IV vs. V; P = 0.005), DM subtype (pure vs. combined; P = 0.01), tumor mitotic rate (<1, 1-4, >4 mitoses/mm2; P = 0.01), and tumor thickness (<1 mm, 1-4 mm, >4 mm; P = 0.02). Only histologic subtype (P = 0.02) and Clark level (P = 0.05) were independently significant by Cox regression analysis. Our results indicate that distinguishing pure from combined forms of DM is clinically relevant for prognosis (pure forms being associated with longer disease-specific survival). Failure to make this distinction may account for conflicting reports in the literature on the biologic behavior and prognosis of DM. |
| Keywords: | adolescent; adult; cancer survival; child; controlled study; human tissue; school child; aged; aged, 80 and over; middle aged; survival analysis; survival rate; retrospective studies; major clinical study; clinical feature; disease course; histopathology; review; follow up; cell proliferation; melanoma; skin neoplasms; melanocyte; tumor volume; fibrosis; prognostic factors; stroma; spindle cell; desmoplastic melanoma; mitosis rate; kaplan meier method; cancer classification; regression analysis; parameter; phenotypic variation; desmoplastic; humans; prognosis; human; male; female |
| Journal Title: | American Journal of Surgical Pathology |
| Volume: | 28 |
| Issue: | 11 |
| ISSN: | 0147-5185 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2004-11-01 |
| Start Page: | 1518 |
| End Page: | 1525 |
| Language: | English |
| DOI: | 10.1097/01.pas.0000141391.91677.a4 |
| PROVIDER: | scopus |
| PUBMED: | 15489657 |
| DOI/URL: | |
| Notes: | Am. J. Surg. Pathol. -- Cited By (since 1996):66 -- Export Date: 16 June 2014 -- CODEN: AJSPD -- Source: Scopus |
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