Cytologic Features of Metastatic and Recurrent Melanoma in Patients With Primary Cutaneous Desmoplastic Melanoma

Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
American Journal of Clinical Pathology (Impact Factor: 2.51). 12/2008; 130(5):715-23. DOI: 10.1309/AJCPG4QZHLWFXMFJ
Source: PubMed


Desmoplastic melanoma (DM) is a rare subtype of melanoma characterized by malignant spindle cells associated with prominent fibrocollagenous stroma. Primary melanomas may be entirely desmoplastic ("pure" DM) or exhibit a desmoplastic component admixed with a nondesmoplastic component ("combined" DM). The cytologic features of only 5 cases of DM have been reported previously. Fine-needle biopsy (FNB) specimens from 20 recurrent or metastatic lesions in patients with cutaneous DM and 20 recurrent or metastatic lesions from patients with primary cutaneous non-DM were examined and compared. FNB specimens of patients with DM were less cellular (P = .009) and less often exhibited intranuclear cytoplasmic invaginations (P = .008) and mitotic figures (P = .006) than specimens from patients with non-DM. "Combined" DMs were more commonly composed of epithelioid cells (P = .017) and less often contained bizarre/giant tumor cells (P = .010) than did "pure" DMs. Recurrent and metastatic DM has a range of cytologic appearances. Awareness of the cytologic features and careful clinicopathologic correlation will assist in accurate FNB diagnosis.

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    • "The combined or mixed forms contain desmoplasia in less than 10% of the lesion, with or without heteromorphism (presence of disparate phenotypes in a single neoplasm). The phenotypic elements include: epithelioid cells, Murali et al., 2008,[11] macrophages, smooth muscle, fibroblast-like cells, multinucleated cells, heterotopic bone, lentigo maligna epidermal component, nerve filaments, perivascular lymphoproliferation and focal lymphocytic aggregates. "
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