Conic Ruzica Z, Ko Jennifer, Allam Sherihan H, Atanaskova-Mesinkovska Natasha, Kovalyshyn Ivanka, Bergfeld Wilma, Gastman Brian R
Ann Plast Surg. 2018 Mar;80(3):277-281. doi: 10.1097/SAP.0000000000001225.
Desmoplastic melanoma (DM) is a subvariant of spindle cell melanoma, accounting for less than 4% of all cutaneous melanomas. It occurs later in life and is associated with chronic sun exposure. Desmoplastic melanoma prognosis is considered more favorable than other variants, with lower rates of metastasis and higher survival. Recently, DM has been further subclassified into pure and mixed, calling into question surgical management and patient outcomes as well as viability of current nationwide databases without this distinction.
We identified all patients with a histopathologic diagnosis of DM from the Cleveland Clinic electronic melanoma database (n = 58) from 1997 to 2013. Clinical and histopathologic data were collected. Comparison in clinical variables was performed between patients who had pure (n = 15) and mixed (n = 43) variants of DM.
There were no differences in age, sex, location of lesion, Breslow depth, ulceration, or regression. Patients with mixed DM were more likely to have lymphovascular invasion (P = 0.03) compared with pure DM. There was no difference in performance of sentinel lymph node biopsy (P = 0.25) or sentinel lymph node positivity (P = 0.31) between the 2 groups. Recurrence was present in 13.3% of pure and 30.2% of mixed patients. Overall, Kaplan-Meier 3-year survival was 75% for pure and 80% for mixed DM (P = 0.53).
Pure and mixed DMs seem to have similar clinical characteristics and outcomes. This indicates that analysis of national datasets without this subclassification remains viable.
促纤维增生性黑色素瘤（DM）是梭形细胞黑色素瘤的一个亚型，占所有皮肤黑色素瘤的比例不到4%。它在生命后期出现，与长期阳光照射有关。促纤维增生性黑色素瘤的预后被认为比其他亚型更有利，转移率较低，生存率较高。最近，DM被进一步细分为纯合型和混合型，这使得手术管理、患者预后以及当前全国性数据库在没有这种区分情况下的可行性受到质疑。
我们从克利夫兰诊所电子黑色素瘤数据库中识别出1997年至2013年期间所有经组织病理学诊断为DM的患者（n = 58）。收集了临床和组织病理学数据。对纯合型（n = 15）和混合型（n = 43）DM患者的临床变量进行了比较。
在年龄、性别、病变部位、Breslow深度、溃疡或消退方面没有差异。与纯合型DM相比，混合型DM患者更有可能发生淋巴管侵犯（P = 0.03）。两组之间前哨淋巴结活检的表现（P = 0.25）或前哨淋巴结阳性率（P = 0.31）没有差异。纯合型患者的复发率为13.3%，混合型患者为30.2%。总体而言，纯合型DM的Kaplan-Meier 3年生存率为75%，混合型为80%（P = 0.53）。
纯合型和混合型DM似乎具有相似的临床特征和预后。这表明在没有这种亚分类的情况下对国家数据集进行分析仍然可行。
