Outcome and complications of epidural analgesia in patients with chronic cancer pain

✍ Scribed by Sebastiano Mercadante

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 62 KB
• Volume: 85
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19990601)85:11<2493::aid-cncr29>3.0.co;2-u

✦ Synopsis

Experience with 280 Patients I n their article on desmoplastic and desmoplastic neurotropic mel- anoma Quinn et al. 1 have extended our knowledge of this unusual subtype of melanoma. However, the authors do not address the question of whether there is any difference in the biologic behavior of desmoplastic melanoma that arises within a "conventional" melanoma, one with an atypical intraepidermal melanocytic component, and "de novo" desmoplastic melanoma, one in which there is little or no atypical intraepidermal melanocytic "precursor." This classification first was proposed by Jain and Allen in 1989 but has received little attention since. 2 We reviewed the subsequent literature including the large series of desmoplastic melanomas reported by Skelton et al. and Smithers et al. 3,4 None of these series differentiated their cases according to this classification. We believe that distinguishing between these two groups of desmoplastic melanoma is important. It is clear that the "de novo" desmoplastic melanoma is more difficult to diagnose, both clinically and histologically, than desmoplastic melanoma arising in a conventional melanoma. Therefore it is likely that the "de novo" lesions comprise the majority of desmoplastic melanomas that are treated inadequately. The delay in treatment may lead to a higher recurrence rate and thereby convey a worse prognosis for patients with this subtype of neoplasm.

We would speculate that de novo desmoplastic melanoma, if diagnosed correctly and excised adequately, may have a significantly better prognosis than conventional melanoma of comparable thickness and we would hope that Quinn et al. would be able to draw on their large series of cases to address this issue.