What is Desmoplastic Melanoma?

Desmoplastic melanoma is a rare variant of cutaneous melanoma known for its dense fibrous stroma. It often presents as a firm, non-pigmented lesion and is most commonly found in sun-exposed areas of older individuals. Due to its subtle appearance, it can easily be mistaken for benign lesions, leading to delayed diagnosis.

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Causes of Desmoplastic Melanoma

The exact aetiology of desmoplastic melanoma remains poorly understood. However, several risk factors have been identified:

These factors underscore the importance of regular skin checks, especially for individuals at higher risk.

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Symptoms of Desmoplastic Melanoma

Desmoplastic melanoma often presents with non-specific symptoms, which can complicate early detection. Key symptoms include:

Due to its subtle presentation, any persistent skin changes should prompt a medical evaluation, particularly in older adults.

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Diagnosing Desmoplastic Melanoma

Accurate diagnosis of desmoplastic melanoma is challenging due to its atypical presentation. A comprehensive diagnostic approach includes:

Clinical Examination

A thorough skin examination by a dermatologist is the first step. Desmoplastic melanoma often appears as a firm, scar-like lesion, which may lack the typical pigmentation seen in other melanomas.

Dermatoscopy

This non-invasive technique uses a dermatoscope to provide a magnified view of skin lesions. Dermatoscopy can reveal subtle features characteristic of desmoplastic melanoma, aiding in early detection.

Biopsy and Histopathological Analysis

A biopsy is essential for confirming the diagnosis. Histological examination typically reveals a dense fibrous stroma with spindle-shaped melanocytes. Immunohistochemical staining can further assist in differentiating desmoplastic melanoma from other skin cancers.

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Treatment of Desmoplastic Melanoma

Effective management of desmoplastic melanoma requires a multidisciplinary approach, involving dermatologists, oncologists, and surgeons.

Surgical Excision

Wide local excision is the primary treatment modality for desmoplastic melanoma. Due to its tendency for neural invasion, achieving clear surgical margins is critical to minimize recurrence risk.

Radiotherapy

Adjuvant radiotherapy may be considered in cases with positive margins or high-risk features. It has shown efficacy in reducing local recurrence rates.

Immunotherapy

Recent advances in immunotherapy, particularly the use of checkpoint inhibitors, have shown promise in managing advanced desmoplastic melanoma. These therapies enhance the immune system's ability to target and destroy cancer cells.

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Prognosis of Desmoplastic Melanoma

The prognosis for desmoplastic melanoma varies based on several factors, including the stage at diagnosis and the adequacy of surgical margins. Generally, it has a lower metastatic potential compared to other melanoma types but a higher risk of local recurrence. Early detection and complete surgical excision significantly improve outcomes.

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Desmoplastic Melanoma vs. Melanoma

While both share the melanocytic origin, desmoplastic melanoma differs significantly from conventional melanoma in its clinical and histopathological presentation. Unlike typical melanomas, desmoplastic variants are less pigmented and more fibrous, making them harder to detect. They also show a propensity for neural invasion, which can complicate surgical management.