Desmoplastic melanoma

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Desmoplastic melanoma
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Skin lesion, nodule, ulceration
Complications	Metastasis, local recurrence
Onset	Typically in adulthood
Duration	Chronic
Types	N/A
Causes	Ultraviolet radiation, genetic mutations
Risks	Sun exposure, fair skin, family history
Diagnosis	Biopsy, histopathology
Differential diagnosis	Scar, neurofibroma, sclerosing nevus
Prevention	N/A
Treatment	Surgical excision, radiation therapy, immunotherapy
Medication	N/A
Prognosis	Variable, depends on stage and treatment
Frequency	Rare, accounts for 1-4% of melanoma cases
Deaths	N/A

Desmoplastic melanoma is a rare subtype of melanoma, a type of skin cancer that arises from the melanocytes, the cells responsible for producing melanin, the pigment that gives skin its color. This form of melanoma is characterized by a dense fibrous stroma, which can make it difficult to diagnose.

Clinical Features

Desmoplastic melanoma often presents as a firm, non-pigmented nodule or plaque on the skin. It is most commonly found on sun-exposed areas, particularly the head and neck region of older adults. Unlike other melanomas, desmoplastic melanoma may not exhibit the typical ABCDE characteristics (Asymmetry, Border irregularity, Color variation, Diameter, and Evolving nature) associated with melanoma.

Pathology

The histological hallmark of desmoplastic melanoma is the presence of spindle-shaped melanocytes within a dense, fibrous stroma. This desmoplastic reaction can make the tumor appear similar to other fibrous tumors, complicating diagnosis. Immunohistochemical staining is often used to differentiate desmoplastic melanoma from other lesions.

Diagnosis

Diagnosis of desmoplastic melanoma typically involves a combination of clinical examination, dermoscopy, and histopathological analysis. A biopsy is essential for confirming the diagnosis. Due to its atypical presentation, desmoplastic melanoma is often diagnosed at a later stage compared to other melanomas.

Treatment

The primary treatment for desmoplastic melanoma is surgical excision with clear margins. Due to its propensity for local recurrence, wide local excision is often recommended. Sentinel lymph node biopsy may be considered, although the likelihood of lymphatic spread is lower compared to other melanoma subtypes. Adjuvant therapies, such as radiation or immunotherapy, may be considered in certain cases.

Prognosis

The prognosis for desmoplastic melanoma can vary. While it has a lower rate of lymphatic spread, it is more likely to recur locally. Early detection and complete surgical excision are critical for improving outcomes.

See also

• Melanoma
• Skin cancer
• Melanocytes
• Immunohistochemistry