Dr. Contreras on the Use of Surgical Resection in Desmoplastic Melanoma

Carlo Contreras, MD, a surgical oncologist for Skin and Soft Tissue Cancers, a member of the Translational Therapeutics Program, medical director of Ambulatory Services at The Ohio State University Comprehensive Cancer Center (OSUCCC)–James, and an associate professor in the Division of Surgical Oncology at The Ohio State University, discusses how continued investigations in desmoplastic melanoma could better inform the use of surgical resection in select patients.

Surgical management is considered the standard first-line treatment approach in primary cutaneous melanoma. However, it can be associated with a higher risk of local recurrence. Future research in desmoplastic melanoma could address this challenge by improving the identification of patients who may not require surgical resection after successful completion of neoadjuvant therapy, Contreras begins. Moreover, it is important to better guide the extent of melanoma excision required for a given patient, Contreras says, adding that the differentiation of this subgroup is especially challenging within desmoplastic melanoma.

Although recent data have shown that bypassing immediate surgical resection can still lead to encouraging responses, many patients will still experience disease recurrence in the absence of resection, Contreras explains. Such patients may outwardly exhibit a complete clinical response, but this does not always correlate with a complete pathologic response upon review, Contreras continues. These patients will instead continue to experience disease progress on initial neoadjuvant treatment, he says. Accordingly, this patient population is considered high risk, Contreras notes.

Instead of progressing to immediate surgical resection, these patients who did not favorably respond to initial neoadjuvant treatment could first undergo dose escalation of their neoadjuvant regimen, Contreras says. This approach may provide greater benefit to high-risk patients compared with an aggressive systemic regimen, Contreras states. However, if the tumor is encroaching upon essential anatomical structures, these patients may still benefit from earlier, more aggressive surgical resection, Contreras concludes.