Desmoplastic Melanoma

Desmoplastic Melanoma

Soheil Sam Dadras, MD, PhD

Olubukola Babalola

David Cassarino, MD, PhD

DM may resemble an inflamed scar on low-power examination. However, aggregates of lymphoid cells image and prominent solar elastosis image are usually identified and are helpful findings.

High-magnification examination shows hyperchromatic-staining atypical spindle cells image surrounded by abundant collagen image bundles.



  • Desmoplastic melanoma (DM)


  • Desmoplastic/neurotropic melanoma


  • Form of invasive melanoma composed of spindle cells associated with dense stromal collagen, resembling a scar



  • Age

    • Presents in sun-damaged skin of elderly adults


  • Firm skin-colored, tan or pink plaque or nodule

  • Sometimes depressed

  • Often amelanotic


  • Surgical approaches

    • It is important to resect DM with clear surgical margins as early as possible for successful clinical management

    • There is increasing evidence that sentinel lymph node biopsy may not be indicated for “pure” variants of DM because of the low incidence of regional lymph node metastases


  • Tumor thickness

  • Clark level (IV vs. V)

  • Histological subtype: “Pure” (longer disease-free survival) vs. “combined”

    • “Pure” subtype is defined as > 90% scar-like areas

    • “Combined” subtype is defined as densely cellular spindle cell collections without significant scar-like areas (> 10%)

  • Tumor mitotic rate


Histologic Features

  • Ill-defined spindle cell neoplasm with highly infiltrative pattern of growth

  • Overlying epidermis may show melanoma in situ (usually lentigo maligna type)

  • Stromal collagen on scanning magnification resembles a scar

  • Spindle cells are arranged in fascicles and merge with scar-like areas

  • Cellular density and cytologic atypia can vary based on histologic subtype

  • Discrete dermal lymphoid aggregates

  • Solar elastosis

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Desmoplastic Melanoma

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