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Morphologic diversity in malignant melanomas.

R E Nakhleh1, M R Wick, A Rocamora

  • 1Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis.

American Journal of Clinical Pathology
|June 1, 1990
PubMed
Summary
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Malignant melanomas can mimic other cancers with unusual histologic patterns. Specialized tests are crucial for accurate diagnosis, especially in diverse tissue sites.

Area of Science:

  • Pathology
  • Dermatology
  • Oncology

Background:

  • Malignant melanoma can present with varied morphologic features.
  • Some amelanotic melanomas exhibit unusual histologic patterns, potentially leading to misdiagnosis.

Purpose of the Study:

  • To identify and characterize variant morphologic patterns of malignant melanoma.
  • To highlight melanomas that may be confused with other neoplasms.

Main Methods:

  • Review of 335 malignant melanomas.
  • Selection and detailed study of 27 amelanotic neoplasms with unusual histology.
  • Diagnostic confirmation using Fontana-Masson stains, electron microscopy, and immunohistochemistry (cytokeratin, vimentin, S-100 protein, HMB-45).

Main Results:

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  • Identified patterns included adenoid/pseudopapillary (9), small cell (7), myxoid stroma (5), hemangiopericytoma-like (4), and signet-ring cell (2).
  • These patterns were observed in primary, secondary, and recurrent melanomas across various sites (vulvovaginal, sinonasal, rectal).
  • All cases were confirmed as melanoma via specific diagnostic studies.

Conclusions:

  • Malignant melanomas can histologically resemble adenocarcinomas, small cell carcinomas, and sarcomas.
  • Detecting melanocytic differentiation is essential for accurate diagnosis in challenging cases.
  • Awareness of these variant patterns aids in differential diagnosis across multiple anatomical locations.