Desmoplastic melanoma: Recent advances and persisting challenges

Wood, Benjamin A.

doi:10.1097/pat.0b013e3283631c96

Cited by 28 publications

(34 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Molecular biology studies can offer additional information that sometimes allow a differential diagnosis between DM and MPNST, but unfortunately BRAF and RAS mutation are usually absent in DM and occasionally MPNST display the V600E mutation . Similarly, DM can reveal a neurofibromin 1 ( NF1 ) gene alteration similar to some MPNST …”

Section: Discussionmentioning

confidence: 99%

“…1,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The most challenging differential diagnosis is between desmoplastic melanoma (DM) and cutaneous MPNST as both neoplasms show S100 positivity (mainly the epithelioid variant of MPNST) and can lack IHC markers of melanocytic differentiation. [4][5][6][7][8][9][10][19][20][21][22][23][24] DM is a rare variant of melanoma, typically arising in chronically sun-damaged skin on the head and neck in elderly patients. 4,[18][19][20][21][22][23][24][25][26][27][28][29] This variety presents significant challenges to the clinician and histopathologist as many cases show a bland appearance, mimicking a scar (paucicellular or pure variant).…”

mentioning

confidence: 99%

“…In addition, the tumor cells of the mixed DM variant are characterized by areas of high-cell density with fascicular or sheet-like growth with no or only minimal intervening fibrous stroma. 4,[18][19][20][21][22][23][24] Amelanotic DM is common and the morphology closely resembles an MPNST. 13,14,[19][20][21][22][23][24]30 DM diagnosis can be particularly problematic in small biopsy specimens, a difficulty complicated by an atypical immunoprofile.…”

mentioning

confidence: 99%

“…4,[18][19][20][21][22][23][24] Amelanotic DM is common and the morphology closely resembles an MPNST. 13,14,[19][20][21][22][23][24]30 DM diagnosis can be particularly problematic in small biopsy specimens, a difficulty complicated by an atypical immunoprofile. [18][19][20][21][22][23][24]29 Here, we describe the clinicopathologic features of 3 cases of cutaneous DM with histological features initially misinterpreted as cutaneous MPNST or benign neural tumor.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases

et al. 2017

View full text Add to dashboard Cite

Desmoplastic melanoma (DM) and cutaneous malignant peripheral nerve sheath tumors (MPNST) reveal histological and immunohistochemical similarities, including S100 positivity and negative staining for conventional melanocytic markers. We present 3 cases of cutaneous S100-positive spindle cell tumors in elderly patients, in which first findings led to initial misdiagnoses as cutaneous MPNST and benign peripheral sheath nerve tumor (neurofibroma). The identification of adjacent atypical melanocytic hyperplasia in the overlying skin along with tumor cell proliferation, also in the superficial dermis, the neurotropic component and the absence of any relationship between the tumor and a major nerve, pre-existing neural benign tumor or the existence of stigmata suggestive of neurofibromatosis raised consideration of a DM. Careful attention should be paid to the presence of a firm dermal nodule and atypical scar lesions especially in sun-exposed areas (mainly head and neck region) in elderly patients associated with S100-positive spindle cell proliferation, solar elastosis and adjacent atypical melanocytic proliferation. In such cases, the possibility of a DM should be excluded with caution, especially if the tumor reveals a paucicellular morphology resembling various non-melanocytic neoplasms including malignant or benign peripheral sheath nerve tumors.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases

et al. 2017

View full text Add to dashboard Cite

show abstract

“…4,7 The histological diagnosis of desmoplastic melanomas can be difficult. 24 An important characteristic of this type of melanoma is its propensity for neural invasion, at times with characteristics termed neural transformation, which can have histological resemblance to peripheral nerve sheath tumors, including schwannoma, neurofibroma, 20 and malignant peripheral nerve sheath tumor. 2 This, along with the location of the main surgical specimen in the dorsal root ganglion, almost certainly accounts for the initial misdiagnosis in this case.…”

Section: Postoperative Coursementioning

confidence: 99%

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

Restrepo¹,

Spinner²,

Howe

et al. 2015

JNS

View full text Add to dashboard Cite

P erineural spread is increasingly recognized as a relatively common mechanism of metastasis in many types of malignancies, particularly those involving the head and neck region. This mechanism of tumor spread for metastatic melanoma is well known to occur along the cranial nerves and cervical plexus. 4,9,14,[16][17][18] We describe a rare example of documented perineural spread of melanoma, arising in the mandible and extending along a cranial nerve, the cervical plexus, and into the brachial plexus. We correlate the clinicoradiological features and propose an anatomopathological explanation to support the mechanism of perineural spread in this case. case report HistoryA 48-year-old right-handed woman presented in 2010 with a several-month history of progressive numbness, tingling, itching, and atrophy affecting the skin and muscles of the right neck. MRI of the cervical spine revealed right C2-3 and C3-4 foraminal masses (Fig. 1 left). The patient underwent observation. Repeat MRI performed 7 months later showed spinal cord displacement at the level of C-2 ( Fig. 1 right). The patient underwent an open biopsy-the findings of which were consistent with a neurofibromaand 1 week later, C2-4 laminectomy, decompression, and fusion. The lesion was partially resected. Postoperatively, the patient received 45-Gy radiotherapy to a field from the top of C-2 to the bottom of C-6, including the spinal cord as well as an 18-Gy boost to the right-sided upper cervical roots and nerves. Brain MRI findings at that time were normal. The brachial plexus was not imaged.Over the next 2 years the patient had persistent cervical discomfort and progressive pain in her right shoulder and then the biceps region. Neither partial removal of the instrumentation nor steroid injections provided relief of her pain, which progressed as time passed. In 2013 she was evaluated at a tertiary care facility when she noted weakness in shoulder abduction and external rotation. Imaging now revealed plexiform lesions involving multiple cervical nerves and the upper brachial plexus. Pathological specimens were reviewed and the findings were interpreted as hybrid schwannoma/neurofibroma. The patient was thought to have a segmental form of schwannomatosis.The patient had a history of melanoma. In 2001, she had a lesion excised from her trunk with no local recurrence. In 2004, she had a nearly 2-cm lesion excised from the angle of the right jaw, a fusion of lentigo maligna and desmoplastic types. It was invasive to Clark's Level IV 5 and Breslow's 3 depth 3 mm.The mitotic rate was 0. Local perineural invasion was evident in the specimen. Tumor was present at the biopsy margins. The BRAF was wild type. Findings from the sentinel cervical lymph node biopsy were negative. Physical ExaminationIn February 2014, the patient presented to our institution. Physical examination revealed atrophic right neck Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in th...

show abstract