Case Number : Case 767 - 27th May Posted By: Guest

Desmoplastic melanoma?

I am always concerned with clinical sclerotic plaques on the face and cheek accompanied by dermal sclerosis and chronic inflammatory infiltrate. Desmoplastic melanoma x cicatricial fibrosis. S-100 and Sox-10 are good options for immunohistochemical evaluation.

I have the same concern, will consider this first possibility.

Desmoplastic melanoma

Agree

Like my colleagues, I think desmoplastic melanoma must be considered every time one deals with a scar-like lesion on chronically sun-damaged skin of head and neck, mainly in eldery patients.
In the pictures shown here there are some microscopic features that favor desmoplastic melanoma over its differential diagnosis:
● fascicles of bland amelanotic spindle cells embedded in a somewhat myxoid stroma;
● spindle cells permeate throughout the dense collagenized dermis and extend into the subcutaneous fat;
● some nodular patchy lymphoid infiltrates;
● scattered pleomorphic cells close to fat cells.
Last but not least, I'd ask the attending physician if there's a history of previous surgical intervention on the biopsied site. It could be another type of melanoma locally recurring with desmoplastic appearance.

Like my colleagues, thinking of [color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Desmoplastic melanoma.Lymphoid infiltrates are a good clue.[/size][/font][/color]

Agree

Agree

[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]Desmoplastic melanoma[/size][/font][/color]

Desmoplastic melanoma

Dear All. If you would like to consider another diagnosis as there was no cytological atypia. Iskander

[quote name='Guest' timestamp='1369736347']
Dear All. If you would like to consider another diagnosis as there was no cytological atypia. Iskander
[/quote]
My first impression was actually inflammatory morphoea. But since everyone was unanimous about desmoplastic melanoma, chose to keep quiet !! The differential would include an old scar/ ruptured & healed cyst (though no cyst lining seen). There is some palisading of inflammatory cells around irregularly distributed nodules of scar tissue, though I couldn't convince myself of a frank granuloma's or necrobiosis (considering atypical facial necrobiosis).

Presumably it is morphoea then.

Do not feel it is inflammatory, more with a spindle cell tumor with dense sclerotic collagenous stroma. Could it be hypopigmented blue nevus. it is said in McKee's book that it overlaps and may be identical to sclerosing (desmoplastic) blue nevus. Also it said that it may show concentric or laminated sclerosis resembling storiform collagenoma which I can perceive vaguely in some areas... Hope I am correct.

Sclerosing perineuroma

This was my first impression after excluding desmoplastic melanoma Dr Engin but the site is so atypical... But it could be!!!

Thanks for the additional comments everyone, the diagnosis for this was morphea, well done to Sasi!

Well done Dr Sasi :-)

Wow