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Cutaneous desmoplastic melanoma.

Klaus J Busam1

  • 1Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. busamk@mskcc.org

Advances in Anatomic Pathology
|February 26, 2005
PubMed
Summary

Desmoplastic melanoma (DM), a fibrosing spindle cell cancer, often presents subtly in sun-damaged skin. While prone to recurrence, pure DM in thick melanomas may indicate a favorable survival prognosis.

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Area of Science:

  • Dermatology
  • Oncology
  • Pathology

Background:

  • Desmoplastic melanoma (DM) is a rare, fibrosing variant of spindle cell melanoma.
  • It typically appears as an indurated lesion on sun-damaged skin, often diagnosed late.
  • DM exhibits significant morphologic variability and can be misdiagnosed as other skin lesions.

Purpose of the Study:

  • To summarize the key clinical, histological, and prognostic features of desmoplastic melanoma.
  • To highlight diagnostic challenges and immunophenotypic characteristics.
  • To discuss the distinct clinical course and prognostic implications of DM compared to conventional melanoma.

Main Methods:

  • Review of clinical presentations and histological findings in desmoplastic melanoma.
  • Analysis of immunophenotypic markers, including S-100 protein and melanocyte differentiation antigens.
  • Evaluation of clinical outcomes, focusing on recurrence rates, metastasis, and survival prognosis.

Main Results:

  • DM often presents in chronically sun-damaged skin and is challenging to detect early.
  • Histologically, DM can be pure or combined, with some showing neurotropic features.
  • Immunophenotypically, DM is typically S-100 positive but often negative for common melanocyte markers.
  • DM has a higher local recurrence rate but fewer lymph node metastases than conventional melanoma.
  • Pure DM in thick melanomas may be a favorable prognostic factor for survival.

Conclusions:

  • Desmoplastic melanoma presents unique diagnostic and clinical challenges.
  • Its distinct immunophenotype and clinical behavior necessitate specialized diagnostic approaches.
  • Understanding the prognostic implications, particularly the favorable outlook for pure DM in thick lesions, is crucial for patient management.

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