Busam Klaus J
Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA; Weill Medical College of Cornell University, New York, NY, USA.
Surg Pathol Clin. 2009 Sep;2(3):511-20. doi: 10.1016/j.path.2009.08.009. Epub 2009 Oct 29.
Desmoplastic melanoma (DM) is a variant of spindle cell melanoma characterized by the presence of abundant fibrous matrix. It is typically found in the head and neck region on chronically sun-damaged skin of older individuals. Early detection is uncommon, because its clinical features are not distinctive. DM is prone to misdiagnosis not only clinically but also histologically. It may simulate a sclerosing melanocytic nevus and various benign and malignant nonmelanocytic lesions. Among melanomas said to be desmoplastic by various pathologists there is significant variation with regard to the extent of intratumoral fibrosis. It may be prominent throughout the entire tumor (pure DM) or represent a portion of an otherwise nondesmoplastic melanoma (combined DM). Immunophenotypically, DM are usually strongly and homogeneously positive for S-100 protein, but are often negative or only focally positive for melanocyte differentiation antigens. DM differs from conventional melanoma in its clinical course. It is associated with a higher tendency for local recurrence, but metastases to regional lymph nodes are less common.
促纤维增生性黑色素瘤（DM）是梭形细胞黑色素瘤的一种变体，其特征是存在丰富的纤维基质。它通常见于老年人长期受阳光损伤皮肤的头颈部区域。早期发现并不常见，因为其临床特征并不特异。DM不仅在临床上容易误诊，在组织学上也容易误诊。它可能类似硬化性黑素细胞痣以及各种良性和恶性非黑素细胞病变。在不同病理学家所说的促纤维增生性黑色素瘤中，肿瘤内纤维化程度存在显著差异。它可能在整个肿瘤中都很突出（纯DM），或者是其他非促纤维增生性黑色素瘤的一部分（混合性DM）。免疫表型上，DM通常对S-100蛋白呈强阳性且均匀一致，但对黑素细胞分化抗原常常呈阴性或仅局灶性阳性。DM在临床病程上与传统黑色素瘤不同。它局部复发的倾向较高，但区域淋巴结转移较少见。
