Primary dermal melanoma: clinical behaviour, prognosis and treatment. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Harris, Christopher G.; Lo, Serigne; Ahmed, Tasnia; Scolyer, Richard A.; Ferguson, Peter M.; Karim, Rooshdiya Z.; Lam, Tai Khoa; Lee, Kenneth K.; Shannon, Kerwin F.; Spillane, Andrew J.; Stretch, Jonathan R.; Thompson, John F.; Saw, Robyn PM.
• Is Part Of: European journal of surgical oncology. Volume 46:Issue 11(2020)
• Page Start: 2131
• Page End: 2139
• Publication Date: 2020-11
• Subjects: Primary dermal melanoma -- Melanoma -- Diagnosis -- Pathology -- Treatment -- Solitary dermal melanoma -- Prognosis -- Survival; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.04.043
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Purpose: Primary dermal melanoma (PDM) is a subtype of cutaneous melanoma, confined to the dermis, which poses a challenging clinical dilemma. It may represent a true primary melanoma or a dermal cutaneous metastasis. This study aimed to delineate the histopathological characteristics and prognosis of PDM in a large patient cohort to guide appropriate treatment strategies. Methods: A search of the Melanoma Research Database at Melanoma Institute Australia was conducted to identify all possible PDM patients at our institution diagnosed from 1978 to 2013. Overall, melanoma-specific and disease-free survival outcomes of the PDM group were compared to those of similar cohorts of Stage I-II and Stage IV M1a melanoma patients based on propensity score matching. Results: Sixty-two PDM patients were identified from the MRD with a median follow-up of 6.3 years. Five-year survival was 87.1% and overall survival was 74.2%. PDMs had a significantly improved overall survival (p = 0.0002) and melanoma-specific survival (p = 0.001) compared to Stage I-II controls, however there was no difference in disease-free survival (p = 0.08). PDMs also demonstrated improved overall survival (p < 0.0001), melanoma-specific survival (p < 0.0001) and disease-free survival (p < 0.0001) compared to Stage IV M1a controls. Conclusion: These findings demonstrate that PDMs have a more favorable prognosis compared to stage I-II cutaneous melanomas and suggest that these are in fact true primary lesions. This study thus provides evidence to justify a treatment approach, by way of a wide local excision and possibly sentinel lymph node biopsy, as for early stage primary cutaneous melanomas.