Desmoplastic Melanoma Review

This article is useful




Clinical and Dermoscopic Characteristics of Desmoplastic Melanomas

Objective: To describe and analyze the clinical and dermoscopic characteristics of desmoplastic melanoma (DM) as a function of pathologic subtype and phenotypic traits.

Design: Retrospective case series.

Setting: Eight high-risk dermatology clinics.

Patients: Patients with DM confirmed by histopathologic analysis whose records included a high-quality dermoscopic image.

Main Outcome Measures: Clinical, dermoscopic, and histopathologic features of DM.

Results: A total of 37DMcases were identified. The majority of patients had fair skin, few nevi, and no history

of melanoma. Lentigo maligna was the most frequent subtype of melanoma associated with DM. The most frequent clinical presentation of DM was a palpable and/or indurated lesion located on sun-exposed skin. Fortythree percent of cases were classified as pure DM, and 57% as mixed DM. Pure DM lesions were thicker than mixed DM lesions (4.10 vs 2.83 mm) (P=.22) and were less likely to have an associated epidermal non-DM component (63% vs 100%) (P=.004). Dermoscopically, DMs had at least 1 melanoma-specific structure, the most frequent being atypical vascular structures. Peppering was more frequently seen in pure DM (44% in pure DM vs 24% in mixed DM) (P=.29). In contrast, crystalline structures, polymorphous vessels, and vascular blush were more commonly seen in mixed DM.

Conclusions: Though DM can be difficult to diagnose based on clinical morphologic characteristics alone, dermoscopy has proved to be a useful aid during the evaluation of clinically equivocal lesions or those lesions with a benign appearance. The most common dermoscopic clues observed in DMs included atypical vascular structures, peppering, and occasionally other melanoma specific structures.

JAMA Dermatol.

Published online January 16, 2013.


  1. #1 by Luke Bookallil on February 5, 2013 - 3:22 am

    Thanks Ian,

    We had a patient in Armidale with a palpable tumour growing over many years with nothing to see on the skin macroscpically or in terms of abnormal dermscopy. Two incisional biopsies not helpful. Finally he represented as it continued to grow (he prev didn’t want excisional bx). Dx- DM.

    Very interesting. Thanks Luke

  2. #2 by Paul Martin on February 7, 2013 - 1:03 pm

    Yes, interesting, but too easy to miss. Must just remove any subcutaneous lump palpable the doesn’t fit a ready clinical diagnosis with confident ease. I had a lady 6th decade referred 12 months ago with a palpable quite mobile ‘subcutaneous’ lump upper outer chest below acromioclavicular joint assumed to be a seb cyst. Difficult to be certain if it was skin tethered or not. Clinically suspiciously not a seb cyst, lipoma or node. Present for a year or so, nothing to see on or in the skin. Removed in toto with overlying skin and proved to be DM. Proceeded to right pulmonary middle lobectomy with a contained solitary secondary, now has an enlarging auxiliary node going for biopsy. Paul

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