![]() pDM or mDM may or may not be associated with in situ melanoma in the epidermis and/or follicular epithelium. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. In contrast, mDM has higher cell density than pDM, which may be throughout the entire tumor or manifest as nodule(s) of solid spindle and/or epithelioid melanocytes in a background of otherwise classic pauci-cellular DM (Figure 4). In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The authors certify that they have obtained all appropriate patient consent forms. Palliative care was decided in consultation with the patient and the family, however the patient died 3 days after this photograph.įigure 1: Pigmented ulcerated tumor on the left cheek Misdiagnosis is common since cytological and immunohistochemical features are often indistinguishable from other sarcomatous neoplasms (malignant fibrohistiocytoma, fibrosarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor). Spindle-cell malignant melanoma is a rare morphologic variant of melanoma, characterized by spindle-shaped cells that usually lose immunoexpression of conventional melanoma markers, forming cohesive fascicles along with epithelioid tumor cells. The dramatic clinical evolution motivated the consultation and we performed a skin biopsy, confirming the initial diagnosis. When she presented to us, the lesion, first described as a 1–2 cm pigmented nodule, had turned into an exophytic, black-greyish ulcerated tumor. The patient and family had then refused surgical management. 2013 20:2345-2351.A 90-year-old woman presented with a long-standing cutaneous lesion localized to the left cheek, which was diagnosed elsewhere as an invasive, spindle-cell malignant melanoma 2 years back. Spindle cell features may be seen in the invasive component of various melanomas (lentigo maligna, acral, superficial spreading, nodular). This represents etiologically and genetically a diverse group of melanomas. Desmoplastic melanoma: is there a role for sentinel lymph node biopsy?. Spindle cell melanoma refers to invasive melanomas in which the tumor is predominantly or exclusively composed of spindle cells. A diagnostic algorithm to distinguish desmoplastic from spindle cell melanoma. Two color stains for SMA and S100 demonstrated that these smooth-muscle actin positive cells constituted a separate spindle-cell population, consistent with. Weissinger SE, Keil P, Silvers DN, Klaus BM, et al. Desmoplastic melanoma – the step-child in the melanoma family?. Clinical approach should be nuanced based on this data.Īt SCARS Center, we attempt to simplify this information with a knowledge chart that summarizes the facts and highlights the controversies. Cancers with large cells include some types of lung cancer and lymphoma. Cancers with spindle cells include some breast, gastrointestinal, muscle or other soft tissue, and skin cancers. There is a difference in recurrence rates, lymph node metastases, and mortality. The cell is narrower at both ends than at the middle. These represent a spectrum of subtypes that have variable spindle cell cellularity and collagen density. Histopathology, presentation, surgical resection margins, and temporary closure with xenograftĭesmoplastic melanoma and spindle cell melanoma are two distinct melanoma subtypes that differ clinically and histologically. The patient was treated postoperatively with PD-1 inhibitor, pembrolizumab (Keytruda). Additional 1.2 cm margin was resected for wide clearance creating a 10 x 9 cm defect. Final pathology showed malignant melanoma-spindle cell / desmoplastic type. The most difficult differential diagnosis is between low-grade MPNST and cellular or atypical neurofibroma. The tumor was resected with a 2 cm margin. Second-line melanoma markers (although often lost in spindle cell melanoma), H3K27me3 and molecular testing for BRAF and other melanoma-associated mutations can be used to make the distinction. ![]() Incisional biopsy showed spindle cell melanoma. A 67-year-old man with CLL presents with 3 month h/o 3 cm dense dermal growing scalp mass. The mean diffuse reflection intensity obtained from the spindle cell melanomas was significantly higher than that from the mixed and epithelioid cell.
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