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Desmoplastic Melanomas Mimicking Neurofibromas
Pedram Gerami1,2, Daniel Kim1, Bin Zhang1
1Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
The American Journal of Dermatopathology
|August 1, 2020
Summary
Desmoplastic melanoma, often mimicking benign neurofibroma, presents diagnostic challenges. Key features like fibroplasia and infiltration aid diagnosis, crucial for preventing recurrence and aggressive transformation.
Area of Science:
- Dermatopathology
- Oncology
Background:
- Desmoplastic melanoma (DM) poses diagnostic difficulties, often presenting at advanced T stages.
- Histologically, DM features spindle cells within a fibrous matrix, resembling fibroblasts or Schwann cells.
Purpose of the Study:
- To describe the histological and clinical features of 12 desmoplastic melanoma cases that mimic neurofibroma.
- To identify diagnostic clues that differentiate these cases from true neurofibromas.
Main Methods:
- Histopathological review of 12 desmoplastic melanoma cases.
- Analysis of clinical follow-up data for 8 cases.
- Evaluation of immunohistochemical markers for diagnostic utility.
Main Results:
- Desmoplastic melanoma cases showed features like prominent fibroplasia (100%), poor circumscription (89%), subcutaneous infiltration (78%), and lymphoid aggregates (100%).
- No immunohistochemical markers reliably distinguished neurofibroma-like DM from neurofibroma.
- Four of eight cases with follow-up were initially misdiagnosed as benign, leading to recurrence, with two transforming to a more aggressive phenotype.
Conclusions:
- Specific histological features can suggest desmoplastic melanoma over neurofibroma.
- Misdiagnosis of neurofibroma-like desmoplastic melanoma can lead to delayed treatment and adverse outcomes, including recurrence and malignant transformation.
