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Khan AA, Zaheer S, Gulati P, Ahuja S. Desmoplastic Melanoma of the Chest Wall: a Diagnostic Dilemma. Indian J Surg Oncol 2024; 15:164-167. [PMID: 38511025 PMCID: PMC10948693 DOI: 10.1007/s13193-023-01851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/11/2023] [Indexed: 03/22/2024] Open
Abstract
Desmoplastic melanoma is an extremely rare subtype of malignant melanoma comprising only 1% of all the cutaneous melanomas. Being amelanotic and owing to its histopathological features of spindle cells lying in a collagenized stroma, it is often misdiagnosed as a dermatofibroma or scar tissue. The present case study describes a case of desmoplastic melanoma of the chest wall where the final diagnosis could be arrived at only after an extensive immunohistochemical panel to exclude other spindle cell proliferations.
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Affiliation(s)
- Adil Aziz Khan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Parth Gulati
- Department of Radiology, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Soares CD, Carlos R, Andrade BABD, Cunha JLS, Agostini M, Romañach MJ, Hernandez-Guerrero JC, Mosqueda-Taylor A, Almeida OPD, Jorge J. Oral Amelanotic Melanomas: Clinicopathologic Features of 8 Cases and Review of the Literature. Int J Surg Pathol 2020; 29:263-272. [PMID: 32734791 DOI: 10.1177/1066896920946435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mucosal melanomas are aggressive tumors, rarely observed in the oral cavity. The diagnosis is based on the clinical and microscopical features. Often these tumors had variable amounts of melanin pigmentation. However, when melanin is absent, the tumors are denominated amelanotic, presenting a tendency to misdiagnosis and delayed treatment. The aim of this study was to describe the clinicopathologic features of a series of oral amelanotic melanomas (OAM). Records of all cases of OAM were retrospectively retrieved from oral pathology services from January 2002 to January 2019. Data regarding the clinical features, morphological aspects, immunohistochemical reactions, treatment, and follow-up status were collected. Eight cases of OAM were included, 6 in men and 2 in women (ratio of 3:1) ranging in age from 33 to 77 years (mean 53.6 years). Clinically, the tumors presented as masses or ulcerated swellings. The most common intraoral locations of the tumors were gingiva and palate. Cervical lymph node metastasis was detected in 3 patients at the first examination. All but one patient died from complications of the tumors after a mean follow-up period of 8.5 months. In conclusion, OAM is a very aggressive malignant tumor, and when melanin is absent, an immunohistochemical panel comprising S100, melan A, HMB45, and SOX10 should be performed.
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Affiliation(s)
| | - Román Carlos
- 389723Centro Clínico de Cabeza y Cuello/Hospital Herrera Llerandi, Guatemala City, Guatemala
| | | | | | - Michelle Agostini
- 28125Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | | - Jacks Jorge
- 28132University of Campinas, Piracicaba, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW Mucosal melanoma is of great interest due to its aggressive behavior and less favorable prognosis. The literature is mainly case reports and case series. Here, we will collect the knowledge on mucosal melanoma from the last decade and review the literature. The main focus is being site-specific clinical features, treatment, and prognosis. RECENT FINDINGS The use of immunotherapy gain ground as for others subsets of melanoma. Anti-CTLA-4 and anti-PD-1/ PD-L1 blockade in mucosal melanoma have been evaluated in recent studies. Clinical trials are ongoing. The etiology of mucosal melanomas remains unknown. Head and neck mucosal melanomas are most common. Wide excision surgery is the treatment of choice. The effect of adjuvant therapy on survival remains questionable due to the limited knowledge. Radiotherapy seems to give better local control. The overall five-year survival rate for mucosal melanomas is 0-45%. Recent data indicates that this may be improved by the immunotherapy in the years to come.
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Affiliation(s)
- Simon Skovsted Yde
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark.
| | - Pia Sjoegren
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Martin Heje
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
| | - Lars B Stolle
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus C, Denmark
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Paulo LFBD, Servato JPS, Rosa RR, Oliveira MTF, Faria PRD, Silva SJD, Cardoso SV, Loyola AM. Primary amelanotic mucosal melanoma of the oronasal region: report of two new cases and literature review. Oral Maxillofac Surg 2015; 19:333-9. [PMID: 25934245 DOI: 10.1007/s10006-015-0501-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/20/2015] [Indexed: 02/03/2023]
Abstract
Primary amelanotic mucosal melanoma is a rare entity with challenging histopathological features. Because these tumors are thought to be biologically more aggressive, they have a poorer prognosis than that of pigmented melanomas. In this work, we present a literature review about the clinical, histopathological, and immunohistochemical features of primary amelanotic mucosal melanoma of the oronasal region and report two new cases. Amelanotic mucosal melanoma commonly affects men in the seventh decade of life and tend to have a poor prognosis, as seen by the high incidence of metastasis, recurrences, and, ultimately, death. There is a similar pattern in the clinic-pathological predilections (such as age, gender, primary site, and metastatic potential) of amelanotic mucosal melanoma when comparing with data reported for pigmented lesions. This work reinforces knowledge about amelanotic mucosal melanomas and epidemiologic predilections. The optimal management of this lesion remains controversial.
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Affiliation(s)
- Luiz Fernando Barbosa de Paulo
- Oral Pathology Area, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.,Oral and Maxillofacial Surgery Department, Clinical Hospital, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Roberta Rezende Rosa
- Oral Pathology Area, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Paulo Rogério de Faria
- Department of Morphology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlandia, MG, Brazil
| | - Sindeval José da Silva
- Head and Neck Surgery Department, Clinical Hospital, Federal University of Uberlândia, Uberlândia, Brazil
| | - Sergio Vitorino Cardoso
- Oral Pathology Area, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Adriano Mota Loyola
- Oral Pathology Area, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil.
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Jou A, Miranda FV, Oliveira MG, Martins MD, Rados PV, Filho MS. Oral desmoplastic melanoma mimicking inflammatory hyperplasia. Gerodontology 2012; 29:e1163-7. [PMID: 22612831 DOI: 10.1111/j.1741-2358.2011.00482.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Desmoplastic melanoma (DM) arising in the oral cavity is a rare neoplasm that may be confused with a variety of non-melanocytic benign or malignant lesions. OBJECTIVES To present a case of DM in the oral mucosa mimicking fibrous inflammatory hyperplasia, discusses the difficulties involved in the diagnosis and offers a literature review on the clinicopathologic and immunohistochemincal aspects of this neoplasm. CASE REPORT A 62-year-old white male, smoker, was referred with a chief complaint of pain and swelling in the palate. The oral examination revealed multiple brown-to-black patches and a non-pigmented sessile nodule located on the mucosa of the hard palate. The clinical diagnosis of the pigmented lesions was either oral melanosis or melanoma. The nodular lesion was clinically diagnosed as fibrous inflammatory hyperplasia. Incisional biopsy was performed on the pigmented lesion and the microscopic sections revealed a melanotic macule. The nodular lesions histologically revealed an amelanotic desmoplastic melanoma. CONCLUSIONS Reactive lesions close to a pigmented area should be investigated with great care.
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Affiliation(s)
- Adriana Jou
- Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil
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Cervantes SS, Baugh R. Primary mucosal desmoplastic melanoma of the nasal vestibule: the second case. EAR, NOSE & THROAT JOURNAL 2012; 90:483-5. [PMID: 22033960 DOI: 10.1177/014556131109001008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary mucosal desmoplastic melanoma is an exceedingly rare, potentially devastating disease that is often initially misdiagnosed because of its deceptively benign presentation. We report what we believe is only the second case of mucosal desmoplastic melanoma arising from the nasal vestibule. The patient, a 62-year-old woman, presented with an obstructive, enlarging mass in the nasal cavity. The tumor, which was initially believed to be benign, was excised, but it recurred 12 months postoperatively. The recurrence was excised, but 4 years later, the patient experienced a second recurrence; in this case, the tumor had invaded the cribriform plate and extended to the anterior cranial fossa. The tumor subsequently metastasized to the dura mater, which led to the patient's death. We review the distinction between conventional mucosal melanoma and mucosal desmoplastic melanoma, and we discuss the ways in which the behavior of a desmoplastic melanoma can point to the diagnosis. Because a diagnosis can be difficult to establish, we stress the importance of maintaining a high index of suspicion when evaluating pathologic and immunohistochemical findings in a patient with a recurrent mucosal nasal mass.
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Affiliation(s)
- Sergio S Cervantes
- Department of Otorhinolaryngology, Mayo Clinic Arizona, Phoenix, AZ, USA
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