Balloon cell malignant melanoma of the skin. A clinicopathologic study of 34 cases with histochemical, immunohistochemical, and ultrastructural observations

Kao, Grace F.; Helwig, Elson B.; Graham, James H.

doi:10.1002/1097-0142(19920615)69:12<2942::aid-cncr2820691213>3.0.co;2-0

Cited by 115 publications

(92 citation statements)

References 16 publications

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“…114 Clinically, lesions appear as soft, rubbery, or firm nodules with a polypoid or papillomatous contour whose cut surfaces are grayish white or brown. 115 The prognosis is similar to that of other types of melanoma matched for depth of invasion, with tumor thickness being of greatest importance and the poor patient survival statistics usually reflecting the deep extent of the tumor at the time of presentation. In the largest series on record, 57.5% of patients died with metastatic disease 2 months to 12 years after initial surgery.…”

Section: Clinical Featuresmentioning

confidence: 79%

“…121 In the majority of ultrastructural studies, however, the vacuoles either appear empty or are held to represent degenerating melanosomes in a fashion analogous to the balloon cell change of benign nevi. 115,120,122 This is also likely true of most metastases from balloon cell melanomas, which in one report did not contain glycogen, fat, or melanin. 118 In another case of metastatic balloon cell melanoma, however, the tumor cells were shown by electron microscopy to contain lipid.…”

Section: 120mentioning

confidence: 89%

“…In the largest series on record, 57.5% of patients died with metastatic disease 2 months to 12 years after initial surgery. 115 Primary balloon cell melanoma in brain arising from a melanoblastic meningeal (or diffuse meningeal) nevus has been described. 116 Amelanotic balloon cell melanoma represents a common histologic variant in the spectrum of feline malignant melanoma 117 and has also been described in humans.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…118 In another case of metastatic balloon cell melanoma, however, the tumor cells were shown by electron microscopy to contain lipid. 123 Immunohistochemical studies with antibodies to S100 protein, Melan-A and HMB-45 are positive in balloon cell melanoma and its metastases (Figure 32), 115,118,124,125 whereas neuronspecific enolase preparations tend to decorate cells weakly. 115 …”

Section: 120mentioning

confidence: 99%

“…The latter include clear cell sarcoma of soft parts, atypical fibroxanthoma and granular cell carcinoma with clear cell change, metastatic renal cell carcinoma, clear cell basal cell carcinoma, and malignant clear cell acrospiroma 115 as well as sebaceous carcinoma and clear cell squamous cell carcinoma. Benign nonmelanocytic lesions that merit consideration include lepromatous leprosy, xanthomata and hibernomas, 115 and clear cell dermatofibroma. 126 Regarding the latter, overlying epidermal hyperplasia and a storiform arrangement of spindle cells amidst sclerotic stroma typical of a benign fibrohistiocytic neoplasm are characteristic.…”

Section: Differential Diagnosismentioning

confidence: 99%

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Unusual variants of malignant melanoma

2006

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A potential diagnostic pitfall in the histologic assessment of melanoma is the inability to recognize unusual melanoma variants. Of these, the more treacherous examples include the desmoplastic melanoma, the nevoid melanoma, the so-called 'minimal-deviation melanoma,' melanoma with prominent pigment synthesis or 'animal-type melanoma,' and the malignant blue nevus. Also problematic are the unusual phenotypic profiles seen in vertical growth phase melanomas; these include those tumors whose morphological peculiarities mimic cancers of nonmelanocytic lineage and those melanomas that express aberrant antigenic profiles not commonly associated with a melanocytic histogenesis. Metaplastic change in melanoma, balloon cell melanoma, signet-ring cell melanoma, myxoid melanoma, small cell melanoma and rhabdoid melanoma all have the potential to mimic metastatic and primary neoplasms of different lineage derivations. Abnormal immunohistochemical expression of CD 34, cytokeratins, epithelial membrane antigen, and smooth muscle markers as well as the deficient expression of S100 protein and melanocyte lineage-specific markers such as GP100 protein (ie HMB-45 antibody) and A103 (ie Melan-A) also present confusing diagnostic challenges. In this review, we will discuss in some detail certain of these novel clinicopathologic types of melanoma, as well as the abnormal phenotypic expressions seen in vertical growth phase melanoma. Modern Pathology (2006) 19, S41-S70. doi:10.1038/modpathol.3800516Keywords: melanoma; variants; phenotype; immunohistochemistry; morphology Desmoplastic melanoma Introduction and Clinical FeaturesDemoplastic melanoma is a rare variant of malignant melanoma first recognized in 1971.1 Desmoplastic and neurotropic melanoma may be mistaken clinically for a scar, a fibroma, a basal cell carcinoma, or a fibromatosis. Sometimes there is pronounced mucin deposition that imparts a boggy quality to the lesion. 2,3 The clinical clue to the diagnosis, when present, is cutaneous or mucosal pigmentation overlying a palpable dermal or submucosal nodule. That said, only half of desmoplastic melanomas are clinically pigmented. 3 Desmoplastic melanomas tend to occur in the head and neck area and the upper back [4][5][6][7] but are also seen in mucosal sites such as the vulva or gingiva 8 and in acral locations. Typically, they occur in older patients, with mean ages in the larger series falling into the sixth to eighth decades of life. 4,6,[9][10][11][12][13][14][15] Larger series show a male preponderance of 1.75 to 1. 15 Although any given desmoplastic melanoma can be deeply invasive, when matched for depth of invasion, they are associated with a lesser risk of metastatic disease than conventional melanomas of similar depth. The classical clinical finding is that of a pale or fleshy firm nodule reminiscent of a scar, which tends to delay clinical diagnosis and biopsy. Carlson et al,6 who reported an equal distribution in men and women, found most tumors to be located in the head and neck area (75%) and to be nonpigment...

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Section: Clinical Featuresmentioning

confidence: 79%

Section: 120mentioning

confidence: 89%

Section: Clinical Featuresmentioning

confidence: 99%

Section: 120mentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

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Unusual variants of malignant melanoma

2006

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Association of Clinical, Dermoscopic, and Histopathologic Findings With Gene Expression in Patients With Balloon Cell Melanoma

et al. 2018

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linical, dermoscopic, and histopathologic features of balloon cell melanoma (BCM), a rarely encountered subtype of melanoma, have not been well characterized. Histopathologically, distinguishing a melanoma from a nevus in the setting of prominent balloon cell features may be challenging. This report highlights the clinical, dermoscopic, and histopathologic features of 2 cases of thin balloon cell melanoma, along with the role of adjunctive gene expression profiling in confirming a diagnosis of balloon cell melanoma.

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