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Research Letter |

Desmoplastic Melanoma in African American Patients FREE

Klaus J. Busam, MD; Charlotte Ariyan, MD; Daniel C. Coit, MD
[+] Author Affiliations

Author Affiliations: Departments of Pathology (Dr Busam) and Surgery (Drs Ariyan and Coit), Memorial Sloan-Kettering Cancer Center, New York, New York.


Arch Dermatol. 2010;146(7):796-797. doi:10.1001/archdermatol.2010.149.
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Published online

Desmoplastic melanoma (DM) is an uncommon fibrosing variant of melanoma typically found on chronically sun-damaged skin of elderly white patients.1 However, it can also affect other ethnic groups and occur at a younger age and/or on sun-protected sites.1 Familiarity with DM is relevant for clinicians and pathologists because, for the unwary, it may be confused with a benign lesion such as a fibroma or scar, leading to delayed diagnosis of melanoma.1 We report herein 3 cases of DM in African American women.

Of 249 patients with DM seen at a cancer center, 3 African American patients were found. All 3 were women. At the time of diagnosis, they were 33, 39, and 78 years old (Table), and the tumors were located on the cheek, forearm, and back, respectively. The clinical differential diagnosis included cyst, scar, and fibroma. All patients underwent wide surgical excision of the tumors with negative margins. None of the patients underwent sentinel lymph node mapping.

Table Graphic Jump LocationTable Clinical and Pathologic Findings

All tumors showed classic histopathologic findings of DM: a paucicellular fibrosing spindle-cell proliferation in the dermis and subcutis associated with lymphoid aggregates (Figure 1). Areas with bland fibromalike features (Figure 1B) were identified as were areas with enlarged hyperchromatic fusiform cells (Figure 1C). All tumors were immunoreactive for S-100 protein.

Place holder to copy figure label and caption
Figure 1.

Pure desmoplastic melanoma (case 1). A, There is a fibrosing lesion in the dermis and subcutis with lymphoid aggregates (hematoxylin-eosin, original magnification ×1). B, Fibroma-like area of bland spindle cells; note the lack of an intraepidermal melanoma component (hematoxylin-eosin, original magnification ×40). C, Hyperchromatic spindle cells adjacent to lymphoid aggregate (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location

Two of the lesions were histologically pure DM, with a uniform paucicellular fibrosing phenotype throughout the entire tumor mass (Figure 1). One of the tumors was a mixed variant of DM, which contained both paucicellular spindle-cell areas and hypercellular epithelioid-cell foci (Figure 2).

Place holder to copy figure label and caption
Figure 2.

Mixed desmoplastic melanoma (case 3). A, Paucicellular fibrosing area with lymphoid aggregate (hematoxylin-eosin, original magnification ×40). B, Hypercellular area with dense clusters of epithelioid melanocytes (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location

Tumor thicknesses ranged from 4.7 to 10.5 mm. Mitoses were rare. All tumors showed perineural invasion. None was associated with solar elastosis, vascular invasion, or satellites.

Desmoplastic melanoma is an important subtype of melanoma because it represents a diagnostic pitfall and has a distinct clinical behavior.1 It has a higher rate of local recurrence and lower incidence of sentinel lymph node involvement than conventional melanoma, especially if the DM is histopathologically pure in appearance.2,3 It is of interest that the DMs of the 3 African American women described herein lacked an associated intraepidermal (in situ) melanoma component as well as evidence of solar elastosis, which suggests a cause independent of chronic sun damage.

Most melanomas in African Americans are acral tumors or melanomas of superficial spreading type. Based on Surveillance, Epidemiology, and End Results (SEER) data (1992-2002), 7 of 251 primary invasive melanomas of African Americans were reported as desmoplastic.4 However, they were not further characterized with regard to histopathologic subtype (pure vs mixed) or anatomic site. One case report of a tumor said to be desmoplastic was an acral melanoma.5 After review of its histopathologic illustrations, we interpret it as a mixed DM.5

Herein, we report for the first time to our knowledge the occurrence of pure DMs at nonacral sites in African American women.

ARTICLE INFORMATION

Correspondence: Dr Busam, Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (busamk@mskcc.org).

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Busam, Ariyan, and Coit. Acquisition of data: Busam, Ariyan, and Coit. Analysis and interpretation of data: Busam, Ariyan, and Coit. Drafting of the manuscript: Busam. Critical revision of the manuscript for important intellectual content: Ariyan and Coit. Administrative, technical, and material support: Busam, Ariyan, and Coit.

Financial Disclosure: None reported.

Additional Contributions: Kita Scott, BA, assisted with queries of the institutional melanoma database; Allyne Manzo helped with the digital images; and Jason Bini provided administrative assistance.

Busam  KJ Cutaneous desmoplastic melanoma. Adv Anat Pathol 2005;12 (2) 92- 102
PubMed Link to Article
Hawkins  WGBusam  KJBen-Porat  L  et al.  Desmoplastic melanoma: a pathologically and clinically distinct form of cutaneous melanoma. Ann Surg Oncol 2005;12 (3) 207- 213
PubMed Link to Article
George  EMcClain  SESlingluff  CLPolissar  NLPatterson  JW Subclassification of desmoplastic melanoma: pure and mixed variants have significantly different capacities for lymph node metastasis J Cutan Pathol 2009;36 (4) 425- 432
PubMed Link to Article
Cormier  JNXing  YDing  M  et al.  Ethnic differences among patients with cutaneous melanoma. Arch Intern Med 2006;166 (17) 1907- 1914
PubMed Link to Article
Emanuel  POIdrees  MTLeytin  AKwon  EJPhelps  RG Aggressive osteogenic desmoplastic melanoma: a case report. J Cutan Pathol 2007;34 (5) 423- 426
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Pure desmoplastic melanoma (case 1). A, There is a fibrosing lesion in the dermis and subcutis with lymphoid aggregates (hematoxylin-eosin, original magnification ×1). B, Fibroma-like area of bland spindle cells; note the lack of an intraepidermal melanoma component (hematoxylin-eosin, original magnification ×40). C, Hyperchromatic spindle cells adjacent to lymphoid aggregate (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Mixed desmoplastic melanoma (case 3). A, Paucicellular fibrosing area with lymphoid aggregate (hematoxylin-eosin, original magnification ×40). B, Hypercellular area with dense clusters of epithelioid melanocytes (hematoxylin-eosin, original magnification ×100).

Graphic Jump Location

Tables

Table Graphic Jump LocationTable Clinical and Pathologic Findings

References

Busam  KJ Cutaneous desmoplastic melanoma. Adv Anat Pathol 2005;12 (2) 92- 102
PubMed Link to Article
Hawkins  WGBusam  KJBen-Porat  L  et al.  Desmoplastic melanoma: a pathologically and clinically distinct form of cutaneous melanoma. Ann Surg Oncol 2005;12 (3) 207- 213
PubMed Link to Article
George  EMcClain  SESlingluff  CLPolissar  NLPatterson  JW Subclassification of desmoplastic melanoma: pure and mixed variants have significantly different capacities for lymph node metastasis J Cutan Pathol 2009;36 (4) 425- 432
PubMed Link to Article
Cormier  JNXing  YDing  M  et al.  Ethnic differences among patients with cutaneous melanoma. Arch Intern Med 2006;166 (17) 1907- 1914
PubMed Link to Article
Emanuel  POIdrees  MTLeytin  AKwon  EJPhelps  RG Aggressive osteogenic desmoplastic melanoma: a case report. J Cutan Pathol 2007;34 (5) 423- 426
PubMed Link to Article

Correspondence

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