Dermoscopy of desmoplastic melanoma: Report of six cases
Department of Dermatology, Lyon 1 University, Hôpital de l'Hôtel Dieu, 69288 Lyon Cedex 02, France. British Journal of Dermatology
(Impact Factor: 4.28).
06/2008; 159(2):360-3. DOI: 10.1111/j.1365-2133.2008.08687.x
Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma. Its diagnosis is often delayed by an unusual clinical presentation. The dermoscopic features of DM have not yet been described.
To define the dermoscopic features of DM. Patients and methods A single-institution register-based retrospective study of six cases of histology-proven desmoplastic melanoma for which dermoscopy data were available. The criteria we studied included: network, dots and globules, streaks, regression features, ulceration, number of colours, blue/white veil, and vascular pattern.
Only three cases exhibited one classical feature for a melanocytic lesion; other cases were recognized on the basis of the presence of figures of regression (all six), i.e. white scar-like areas and 'peppering' (three of six), multiple (> 4) colours (five of six), and of melanoma-related vascular patterns (five) such as linear-irregular vessels (four) and milky-red areas (two).
We believe that dermoscopy could help in the accurate diagnosis of this rare neoplasm. In the absence of a pigmented network, attention should be given to the identification of features of regression and to melanoma-associated vascular patterns.
Figures in this publication
Available from: Grazyna Kaminska-Winciorek
- "During observations carried out by Zaballos et al.  concerning 412 dermatofibromas, a pigment network were observed in 71% of lesions and white scar-like areas were noted in a total of 57% of lesions . What is more, the presence of white scar-like areas should always suggest the necessity of ruling out melanoma through a dermoscopic examination – especially its desmoplastic type  or the fully regressive melanoma . Scar-like white areas are a usual histological suggestion of fibrosis . "
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The accessory nipple (AN) is characterised by its network-like structures, which may suggest the diagnosis of a melanocytic lesion. The knowledge about additional dermoscopic features of AN may greatly minimise the risk of unnecessary surgical excisions.
To analyse and present different clinical and dermoscopic forms, in which the AN may appear.
Material and methods
Ninety AN with dermoscopic features were evaluated in the study, detected in 14 patients between the years 2008 and 2014.
The most common dermoscopic features of the AN were central, scar-like areas (15/19) and peripheral network-like structures (12/19). A number of cleft-like appearances (8/19) and central network-like structures (7/19) had also been observed. Moreover, among the dermoscopic features, white cobblestone-like structures (7/19), a central round dimpling with a plug (6/19) and fisheye-like structures resembling comedo-like openings (9/19) have all also been noted. There is a statistical significance in the occurrence of white cobblestone-like structures with central network-like structures (Fisher's exact test p = 0.0449). The presence of peripheral network-like structures with the occurrence of central scar-like areas was statistically highly significant (p = 0.0091). The central round dimpling was never observed alongside any central network-like structures in any of the lesions (p = 0.0436).
Accessory nipples are most commonly characterised by the occurrence of a peripheral network-like structure accompanied by the presence of a scar-like area.
Available from: Juan Piñeiro-Maceira
- "Therefore, it can be clinically misdiagnosed as basal cell carcinoma, scar, dermatofibroma, nevus or cyst. In a recently published series, there was no clinical suspicion of melanoma in up to 2/3 of affected patients.4 "
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ABSTRACT: Desmoplastic melanoma tends to present as firm, amelanotic papules. Microscopically, it reveals a proliferation of fusiform cells in the dermis and variable collagen deposition, as well as intraepidermal melanocytic proliferation of lentiginous type in most cases. Biopsy in a 61-year-old white male patient, who had received a diagnosis of lentigo maligna on his face 10 years before, revealed a proliferation of dermal pigmented spindle cells and collagen deposition, reaching the deep reticular dermis, with a lentiginous component. Immunohistochemistry with S-100, Melan-A and WT1 showed positivity, but it was weak with HMB45. Desmoplastic melanoma associated with lentigo maligna was diagnosed. Several authors discuss whether desmoplastic melanoma represents a progression from the lentiginous component or arises "de novo". Desmoplastic melanoma represents a minority of cases of primary cutaneous melanoma (less than 4%). Identification of lentigo maligna indicates that desmoplastic melanoma should be carefully investigated.
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ABSTRACT: Many tumors are encountered in the nail unit. All components of the nail apparatus produce tumors that exhibit benign behavior in the vast majority of cases. However, the malignant counterpart of every tumor type also exists. Tumors of the nail unit may correspond to tumor types also present elsewhere on skin such as warts, nevi, melanoma and squamous cell carcinoma. In this case their clinical presentation is often influenced by the anatomy and physiology of the nail: longitudinal bands, subungual tumoral syndrome. Some tumors are also present on the rest of skin but are more frequent on the nail unit, such as glomus-cell tumor. Lastly, some tumors are quite specific to the nail unit either because they derive from an adjacent structure that influences the nail plate outgrowth, such as exostoses enchondromas, or because they derive from a nail-specific tissue, such as onychomatricomas. All these particularities of nail apparatus tumors create a specific semiology (melanonychia striata, for example) and often a specific diagnostic strategy (dermoscopy, magnetic resonance imaging, specific biopsy techniques) and, in many cases, a site-specific treatment (conservative melanoma surgery, for example).
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