title: Desmoplastic melanoma: a pathologically and clinically distinct form of cutaneous melanoma.
abstract: BACKGROUND
  Desmoplastic melanoma (DM) is a rare variant characterized by the presence of fusiform melanocytes in a sclerotic stroma. Pathologic heterogeneity within DM may account for the controversy regarding the clinical presentation and prognosis of DM compared with conventional melanoma (CM).
  
  
  METHODS
  We identified 131 patients with a diagnosis of DM seen between 1979 and 2002. Tumors were categorized as either pure DM (pDM; n = 92), if desmoplasia was prominent throughout the entire invasive tumor, or mixed DM (mDM; n = 39), if fibrosis was well developed in only parts of an otherwise non-DM. Differences in clinical behavior among pDM, mDM, and CM (n = 3976) were examined.
  
  
  RESULTS
  Seventy-three percent of patients with DM had tumors >2 mm in depth, compared with 31% of patients with CM (P < .001). Regional nodal metastasis was uncommon in patients who presented with clinically localized pDM (1%) compared with those with mDM (10%) or CM (6%) (P < .05, pDM vs. CM). Five-year melanoma-specific mortality was lower for patients who presented with pDM compared with mDM (11% vs. 31%; P < .01). Patients with pDM and CM had a similar melanoma-specific mortality despite a 3-fold difference in median tumor depth (3.6 vs. 1.2 mm, respectively).
  
  
  CONCLUSIONS
  DMs can be divided into two subtypes based on a histological quantification of desmoplasia. Tumors with prominent fibrosis (pure subtype) are unlikely to disseminate to regional lymph nodes and are associated with a favorable outcome when compared with those with mixed desmoplasia or CM.
authors.affiliation: Department of Surgery, Washington University, St. Louis, Missouri 63110, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
authors.forename: Klaus J
authors.initials: KJ
authors.lastname: Busam
authors.forename: Leah
authors.initials: L
authors.lastname: Ben-Porat
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Panageas
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Coit
authors.forename: David E
authors.initials: DE
authors.lastname: Gyorki
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: Mary S
authors.initials: MS
authors.lastname: Brady
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008544:Melanocytes / Q000473:pathology*; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis