Journal
JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
Volume 75, Issue 12, Pages 4441-4449Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bjps.2022.08.044
Keywords
Sentinel lymph node; Melanoma; Desmoplastic melanoma
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Previous studies have suggested that desmoplastic melanoma is less likely to metastasize to regional lymph nodes when compared with conventional melanoma. This review suggests that it is imperative to distinguish the histologic subtype of desmoplastic melanoma to determine if staging procedure is indicated.
Background: Desmoplastic melanoma (DM) is a less common form of cutaneous melanoma that has been described for decades; however, controversy remains regarding the management and use of sentinel lymph node biopsy (SLNB). The purpose of this study is to identify whether SLNB is indicated in all cases of DM, including the pure subtype.Methods: A systematic review was conducted using PubMed (with access to MEDLINE) along with the Cochrane Central Register of Controlled Trials from 2001 to 2019. Case series and case-control studies were included.Results: Eighteen studies were included for a total population of 3,914 patients. SLNB was per-formed in 2229 patients. The percentage of positive SLNB results was 8.5%. However, patients with pure DM ( > 90% desmoplastic component) were found to have a significantly lower rate of occult metastatic node positivity when compared with that of mixed DM (4.9% and 14.8%, respectively). Conclusions: Our findings underscore the importance of the pathologist reporting percentage of desmoplastic component in melanoma. SLNB should be strongly considered for patients with mixed DM. However, the low rate of occult metastatic node positivity in pure DM is beneath the threshold for using SLNB as a staging procedure.Summary: Previous studies have suggested that desmoplastic melanoma is less likely to metas-tasize to regional lymph nodes when compared with conventional melanoma. This review sug-gests that it is imperative to distinguish the histologic subtype of desmoplastic melanoma to determine if staging procedure is indicated.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.
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