Adjuvant Radiotherapy After Surgical Excision of Desmoplastic Melanoma: A Systematic Review of Local Control and Survival Outcomes

Desmoplastic melanoma (DM) is a rare, aggressive melanoma subtype with high local recurrence rates (20-60%) following surgical excision. This systematic review evaluated the efficacy of adjuvant radiotherapy (RT) in improving local control and survival outcomes in DM patients. Following Preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines, we searched PubMed/MEDLINE, ScienceDirect, Scopus, CINAHL, and EBSCO databases from inception through December 2025.. Thirteen studies (10 retrospective cohorts, 3 prospective trials) met the inclusion criteria. quality assessment using JBI tools revealed 69% high quality and 31% moderate quality studies. Adjuvant RT significantly reduced local recurrence rates from 17.2% (surgery alone) to 7.6% (surgery plus RT), representing a 56% relative risk reduction. All hypofractionated RT (e.g. 30 Gy/5 fractions) achieved comparable local control rates (90-95% at 5 years). High-risk features including positive margins, Breslow depth ˃4 mm, and neurotropism identified patients deriving greatest benefits from RT. Adjuvant radiotherapy significantly improves local control in DM following surgical excision and should be considered standardized of care for high-risk patients. Future randomized trials are needed to established definitive treatment.