Desmoplastic Malignant Melanoma and Its Variants

Jain, Sanjiv; Allen, Paul

doi:10.1097/00000478-198905000-00003

Cited by 205 publications

(154 citation statements)

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“…5,22,30,31 Busam et al 22 reported the importance of making a distinction between DM with prominent fibrosis (pure DM) from melanomas in which desmoplasia is only a partial component (mixed DMs). In the current study, we sought to examine DM with an emphasis on this histologic distinction.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

Pawlik

Ross

Prieto

et al. 2006

Cancer

109

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Although the correspondence between habitual activity and diaphyseal cortical bone morphology has been demonstrated for the fore‐ and hind‐limb long bones of primates, the relationship between trabecular bone architecture and locomotor behavior is less certain. If sub‐articular trabecular and diaphyseal cortical bone morphology reflects locomotor patterns, this correspondence would be a valuable tool with which to interpret morphological variation in the skeletal and fossil record. To assess this relationship, high‐resolution computed tomography images from both the humeral and femoral head and midshaft of 112 individuals from eight anthropoid genera (Alouatta, Homo, Macaca, Pan, Papio, Pongo, Trachypithecus, and Symphalangus) were analyzed. Within‐bone (sub‐articular trabeculae vs. mid‐diaphysis), between‐bone (forelimb vs. hind limb), and among‐taxa relative distributions (femoral:humeral) were compared. Three conclusions are evident: (1) Correlations exists between humeral head sub‐articular trabecular bone architecture and mid‐humerus diaphyseal bone properties; this was not the case in the femur. (2) In contrast to comparisons of inter‐limb diaphyseal bone robusticity, among all species femoral head trabecular bone architecture is significantly more substantial (i.e., higher values for mechanically relevant trabecular bone architectural features) than humeral head trabecular bone architecture. (3) Interspecific comparisons of femoral morphology relative to humeral morphology reveal an osteological “locomotor signal” indicative of differential use of the forelimb and hind limb within mid‐diaphysis cortical bone geometry, but not within sub‐articular trabecular bone architecture. Am J Phys Anthropol 147:187–200, 2012. © 2011 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

Pawlik

Ross

Prieto

et al. 2006

Cancer

109

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“…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.…”

Section: Introduction and Clinical Featuresmentioning

confidence: 99%

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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“…4,5 In DNM, tumor cells may surround nerves (perineural invasion), directly invade nerve fibers (intraneural invasion), and may even exhibit the histologic appearance of nerve-like structures or nerve sheath tumors (neural transformation). 6,7 Although they often are aggressive locally, the prognosis for DNM appears to be better 'stage for stage' than for other subtypes of melanoma. 8 Therefore, local control is particularly important.…”

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confidence: 99%

Desmoplastic neurotropic melanoma

Chen

Hruby

Scolyer

et al. 2008

Cancer

127

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BACKGROUND.Several studies have suggested that desmoplastic neurotropic melanoma (DNM) is associated with higher local recurrence rates than other types of melanoma. The authors investigated the local recurrence rates for patients with DNM after surgery alone or surgery followed by radiotherapy (RT).METHODS.One hundred twenty‐eight patients with DNM were treated at the Sydney Melanoma Unit and the Sydney Cancer Center from 1996 to 2007. All patients underwent local excision, 27 patients also received RT. For both groups, clinical and pathologic features, treatment details, and local recurrence data were analyzed.RESULTS.The median age at diagnosis was 65.5 years. The ratio of men to women was 2.7:1. The head and neck was the most common location (51%). The median Breslow thickness was 4 mm, and 99% of patients had Clark Level IV or V primary tumors. Patients who received adjuvant RT had thicker tumors (P = .003), deeper Clark level invasion (P < .001), and narrower excision margins (P < .001). There were 8 local recurrences, including 6 (6%) in the surgery only group and 2 (7%) in the adjuvant RT group. A positive margin (P < .001) and head and neck location (P = .03) were significant predictors of local recurrence.CONCLUSIONS.The local recurrence rate in this series was lower than the rates reported in historic control groups and in the authors' previous temporal cohort. The results indicated that clear surgical margins are of paramount importance in minimizing local recurrence; when margins are compromised, the addition of RT may reduce local recurrence rates compared with historic controls. A prospective randomized trial is needed to quantify the risk reduction with adjuvant RT. Cancer 2008. © 2008 American Cancer Society.

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Desmoplastic Malignant Melanoma and Its Variants

Cited by 205 publications

References 0 publications

Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma

Unusual variants of malignant melanoma

Desmoplastic neurotropic melanoma

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