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Top 10 Differential Diagnoses for Desmoplastic Melanoma

  • Special Issue: Top Ten Head and Neck Differentials
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Abstract

Background

Desmoplastic melanoma is a rare subtype of melanoma mainly appearing on sun-exposed skin. Clinically, it is many times non-pigmented and therefore the diagnosis is often not suspected.

Methods

Review article.

Results

In this paper we review the main histopathological, immunohistochemical, and molecular features of desmoplastic melanoma, as well as the top 10 morphologic differential diagnoses which should be considered in most cases. The histopathological pattern can be many times deceptive, mimicking a scar, a fibrous reaction, a fibrohistiocytic tumor such as a dermatofibroma, a vascular tumor such as angiosarcoma, a smooth muscle tumor such as leiomyosarcoma, or a neural tumor. Although an overlying atypical junctional melanocytic proliferation may be seen in most cases, it is absent in a significant percentage (up to 30%) of cases, making the diagnosis even more difficult in those instances. The range of diagnostic pitfalls is wide, which may present disastrous prognostic consequences.

Conclusion

Desmoplastic melanoma is often a difficult diagnosis to make, as it frequently shows nonspecific clinical findings and overlapping histologic features with many other tumors. However, the potential clinical and prognostic consequences of misdiagnosis as another entity are great. Therefore, this diagnosis must always be kept in mind when encountering spindle cell tumors affecting the head and neck area.

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(Courtesy of Dr. Santos-Briz)

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Data Availability

Not applicable (no data generated for this paper).

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain

    Angel Fernandez-Flores

  2. Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain

    Angel Fernandez-Flores

  3. Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain

    Angel Fernandez-Flores

  4. Summit Health, New Providence, NJ, USA

    Rajendra Singh

  5. Departments of Pathology and Dermatology, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Los Angeles, CA, USA

    David S. Cassarino

  6. Department of Pathology, Southern California Permanent Medical Group, Los Angeles Medical Center, 3867 Sunset Blvd, Los Angeles, CA, 90027, USA

    David S. Cassarino

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  1. Angel Fernandez-Flores
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  2. Rajendra Singh
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Correspondence to David S. Cassarino.

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Fernandez-Flores, A., Singh, R. & Cassarino, D.S. Top 10 Differential Diagnoses for Desmoplastic Melanoma. Head and Neck Pathol 17, 143–153 (2023). https://doi.org/10.1007/s12105-023-01536-y

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