Histologic differentiation of desmoplastic melanoma from cicatrices

Nelson K. Kaneishi, Clay J. Cockerell

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Desmoplastic malignant melanoma (DMM) is a rare variant of melanoma that can be very difficult to diagnose correctly both clinically and histologically. The problem is compounded by the fact that many lesions persist at previous biopsy or excision sites so that scar tissue is often present admixed with or adjacent to the spindle cell neoplasm which may exhibit fibroblastic differentiation itself. In order to assess this problem, we compared and contrasted the histologic features of six DMM with 15 examples of cicatrices from various sources. Mature scars were readily differentiated from DMM by light microscopy. In contrast, immature scar and DMM had many features in common including hypercellularity, nodular lymphoid infiltrates, myxoid stroma, and atypical nuclei. The presence of a melanocytic proliferation within the epidermis above the dermal component, neurotropism, and S-100 and/or HMB-45 positivity of neoplastic cells were the only features that permitted reliable differentiation between the two. Clinical correlation and review of previous biopsy specimens are crucial in preventing a delayed diagnosis of DMM. Re-excision is advised in all questionable cases.

Original languageEnglish (US)
Pages (from-to)128-134
Number of pages7
JournalAmerican Journal of Dermatopathology
Volume20
Issue number2
DOIs
StatePublished - Apr 23 1998

Keywords

  • Desmoplasia
  • Diagnosis
  • Melanoma
  • Scar

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Dermatology

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