Skin melanocytic tumor
Desmoplastic melanoma

Topic Completed: 1 May 2013

Minor changes: 28 May 2019

Copyright: 2002-2019,, Inc.

PubMed Search: desmoplastic melanoma "loattrfree full text"[sb]

Christopher S. Hale, M.D.
Page views in 2019: 6,562
Page views in 2020 to date: 3,893
Cite this page: Hale CS. Desmoplastic melanoma. website. Accessed August 3rd, 2020.
Definition / general
  • Rare variant of spindle cell melanoma seen in older adults in sun exposed skin
  • A type of nodular (vertical growth) melanoma with scanty spindle cells, prominent desmoplastic stroma and often minimal atypia
  • First described in 1971 (Cancer 1971;28:914)
  • Also called desmoplastic neurotropic melanoma if neuroma-type features with prominent nerve involvement (Adv Anat Pathol 2005;12:92)
  • 72% in head, neck
Clinical features
  • Often nonpigmented and mistaken for nonmelanocytic lesion, such as scar
  • Usually advanced thickness at presentation (Br J Dermatol 2005;152:673)
Case reports
Clinical images

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2.5 cm scalp lesion

  • Features of regression (white scar-like areas, peppering); also multiple colors, linear irregular vessels or milky red areas (Br J Dermatol 2008;159:360)
Microscopic (histologic) description
  • Poorly circumscribed; focal fascicular pattern of scanty spindle cells with prominent desmoplastic stroma
  • Tumor cells may have minimal atypia
  • Solar elastosis (82%), amelanotic (71%), deep invasion, perineural infiltration (35%), lymphoid aggregates at periphery (37%); may grow in peripheral nerve sheath pattern
  • May be pure or combined with classic melanoma (pure have better prognosis, Am J Surg Pathol 2004;28:1518)
  • 15% have no evidence of intraepidermal melanocytic component
Microscopic (histologic) images

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Desmoplastic versus nondesmoplastic melanoma

Hypocellular spindle cells (fig. 1)

Mixed with classic melanom (fig. 2)

Atypical spindled cells (fig. 1)

81 year old man with scalp lesion

Various images

S100 and T311 (tyrosinase) staining

HMB45 and Mart1 negative

MITF positive

Cytology description
  • Clean background; aggregates of pleomorphic spindle cells mixed with fibrous stroma and single cells
  • Fine, wispy and delicate cytoplasm at nuclear poles, nuclei are elongated and plump with irregular contours, deep grooves and folds and dark coarse chromatin with variably prominent nucleoli (Cytojournal 2007;4:18)
  • Compared to other melanomas, is less cellular and less often has intranuclear cytoplasmic inclusions and mitotic figures (Am J Clin Pathol 2008;130:715)
Cytology images

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Various images

Positive stains
Negative stains
Molecular / cytogenetics description
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