Faculty Collaboration Database

Cutaneous metastases of malignant melanoma: a clinicopathologic study of 192 cases with emphasis on the morphologic spectrum. Am J Dermatopathol 2010 Apr;32(2):129-36

Date

12/17/2009

Pubmed ID

20010406

DOI

10.1097/DAD.0b013e3181b34a19

Scopus ID

2-s2.0-77949965770 (requires institutional sign-in at Scopus site)   72 Citations

Abstract

Metastatic melanoma represents one of the most common types of cutaneous metastases. In up to 5% of patients, metastatic melanoma can be the first manifestation of the disease. For the most part, the histologic diagnosis of metastatic melanoma poses little diagnostic difficulty; however, some metastases may adopt unusual or unfamiliar appearances mimicking other benign and malignant conditions. We present a study of 192 cases of cutaneous metastatic melanomas with special emphasis on their spectrum of morphologic features. The patients were 115 men and 77 women, 23-91 years of age (mean 57 years). Most tumors were located on the proximal legs, scalp, and arms and ranged from 0.8 to 3.0 cm. One hundred ten cases showed the classic morphologic appearance of melanoma (well-circumscribed epithelioid dermal/subcutaneous nodule), 82 cases showed unusual histologic appearances that mimicked other benign and malignant neoplasms. In 16 patients (8.3%), there was no evidence of primary melanoma and the cutaneous metastasis was the only manifestation of the disease. The histologic diagnosis of cutaneous metastatic melanoma can pose difficulties for diagnosis, especially in the face of an unknown primary neoplasm. Unusual features observed in this series included examples of cutaneous metastatic melanoma that closely simulated metastatic carcinoma, dermatofibroma, leiomyosarcoma, angiosarcoma, nevoid melanoma, halo nevus, blue nevi, and atypical fibroxanthoma. Several cases also showed rhabdoid, balloon cell, and alveolar features. Immunohistochemical stains plus careful clinical history helped to establish the correct diagnosis. Our series illustrates that the differential diagnosis of cutaneous metastatic melanoma can be broad and difficult. To the best of our knowledge, this is the largest series of cutaneous metastatic melanomas reported in the literature.

Author List

Plaza JA, Torres-Cabala C, Evans H, Diwan HA, Suster S, Prieto VG

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Antigens, CD
Antigens, CD34
Antigens, Differentiation, Myelomonocytic
Antigens, Neoplasm
Desmin
Diagnosis, Differential
Female
Humans
Ki-67 Antigen
Male
Melanoma
Melanoma-Specific Antigens
Middle Aged
Neoplasm Proteins
Neoplasms, Unknown Primary
Skin
Skin Neoplasms