Desmoplastic melanoma presenting as primary alopecia neoplastica: a report of two cases

Desmoplastic melanoma is an uncommon form of melanoma characterized by atypical spindled melanocytes and abundant collagen deposition. It typically presents in sun‐damaged skin of the elderly as an amelanotic, indurated lesion. It has a higher tendency for local recurrence but lower risk of lymph no...

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Bibliographic Details
Published in:Journal of cutaneous pathology 2016-10, Vol.43 (10), p.872-879
Main Authors: Erstine, Emily M., Elwood, Hillary R., Westbrook, Kent C., McCalmont, Timothy H., Shalin, Sara C., Gardner, Jerad M.
Format: Article
Language:English
Subjects:
Aged
Alopecia
Alopecia - metabolism
Alopecia - pathology
alopecia neoplastica
Baldness
Biopsy
Collagen
Dermis
desmoplastic melanoma
Differential diagnosis
Epidermis
Etiology
Female
Geriatrics
Head and Neck Neoplasms - metabolism
Head and Neck Neoplasms - pathology
Humans
Lymph nodes
Melanocytes
Melanoma
Melanoma - metabolism
Melanoma - pathology
Metastases
Middle Aged
Neoplasm Proteins - metabolism
Patients
S100 protein
S100 Proteins - metabolism
Scalp
Skin cancer
Skin Neoplasms - metabolism
Skin Neoplasms - pathology
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Summary:Desmoplastic melanoma is an uncommon form of melanoma characterized by atypical spindled melanocytes and abundant collagen deposition. It typically presents in sun‐damaged skin of the elderly as an amelanotic, indurated lesion. It has a higher tendency for local recurrence but lower risk of lymph node metastasis vs. conventional malignant melanoma. We report two cases in women aged 59 and 66 who presented with small scalp lesions clinically suggestive of alopecia. The differential diagnosis included alopecia areata, lupus erythematosus and lichen planopilaris. Biopsies performed according to alopecia protocol were reviewed at our institutions. Biopsies revealed atypical spindled and nested epithelioid melanocytes set in a sclerotic dermis with scattered lymphoid aggregates and immunohistochemical expression of S100 protein, features diagnostic of combined desmoplastic melanoma. Wide local excision with skin graft was performed on the older patient. Excision showed combined desmoplastic melanoma with a Breslow thickness of 8.5 mm with melanoma in situ identified in the adjacent epidermis. The other patient sought treatment elsewhere and was lost to follow up. These cases illustrate desmoplastic melanoma as an unusual etiology and dangerous clinical pitfall in patients with scar‐like alopecia. To the authors' knowledge, these represent the second and third reported cases of desmoplastic melanoma presenting as primary alopecia neoplastica.
ISSN:0303-6987
1600-0560
DOI:10.1111/cup.12758