Dermal Melanoma

Here is one more. But please note, these are older publications, this is from 2000. There hasn’t been a great deal of “large” research in the most recent years, basically just case studies. There have been a some retrospective look at the data from historical cases:

https://jamanetwork.com/journals/jamadermatology/fullarticle/190733

Hugs,
Jackie

We all understand the hypochondria, don’t apologize and I’m as guilty as anyone, and when you hear words like melanoma and all the criteria around it can be overwhelming. First, I can’t say whether or not you have primary dermal melanoma, only the pathologist and doctor can do that, but there is still some debate about whether or not this is a distinct type of melanoma. I think the safest approach is to treat it as melanoma which means doing exactly what you are, getting all the information and advocating for yourself and researching all your options. Also, not sure of your system, if you don’t feel your doctor is giving you all the information needed or the correct information about treatment options, always get a second opinion if that is an option and preferrably from a doctor or center that specifically deals with melanoma. . as people on this board will tell you, Interferon is no longer considered a good choice based on the data and showing minimal if any benefit in terms of recurrence and/or survival outcomes . My husband’s doctor at MD Anderson said she would NOT recommend it. And that was in early 2014. The only thing he was offered at that time was IL-2 since no vaccine trials to recruitment were open at that time.

My husband’s tumor showed the NRAS mutation which is seen in aobut 20-30% of melanomas. I can’t really speak to the suspected origin, as the very limited data on this, but here is a portion of Swetter’s article: “Bowen et al1 postulate that primary dermal melanoma may arise from nonepidermal melanocytes, from melanocytes associated with deeper appendageal structures, or from embryologic-melanocyte migration remnants; its true origin remains unclear. Likewise, no specific immunohistochemical staining pattern can be used to differentiate primary dermal melanoma from nodular or metastatic melanoma. The diagnosis of primary dermal melanoma requires clinicopathologic correlation and should be considered in patients with a solitary melanoma confined to the dermis and/or subcutaneous tissue with no identifiable primary site and no evidence of disease elsewhere. Subsequent larger studies are warranted to evaluate appropriate metastatic staging and to confirm the high survival rate for this subtype of melanoma.”

Again, even these articles suggest they couldn’t differentiate and not sure any new research has shown a clear signal. Here is a brief blurb/case study from the Journal of the American Academy of Dermatology from 2018 from a conference presentation, even the title suggests it still is a diagnosis of exclusion:

7907
A case of primary dermal melanoma: A diagnosis of exclusion
Christopher Schwartz, BS, University of South Florida Morsani College
of Medicine; Brooke Baldwin, MD, James A. Haley Veterans Hospital;
Eugene Sanik, DO, James A. Haley Veterans Hospital
Primary dermal melanoma (PDM) is a relatively recent term used to describe a rare
subtype of melanoma that simulates a cutaneous metastasis but is associated with
unexpectedly prolonged survival. Given their infrequent occurrence and metastatic
mimicry, these lesions are often worked up to rule out less indolent skin cancers like
primary nodular melanoma (PNM) and cutaneous metastatic melanoma (CMM).
PDM is often arrived at as a diagnosis of exclusion but our evolving understanding of
the genetic and histologic parameters of such lesions can save patients from
unnecessary radiation, biopsies, and excessive expense. A 67-year-old man with a
history of nonmelanoma skin cancer presented to the dermatology clinic with a
slowly growing right neck mass of 5 months duration. An initial punch biopsy of the
mass was done and revealed a melanoma with no connection to the epidermis. The
patient was sent promptly to ENT for surgical management and lymph node
dissection. The entire skin/mass interface was submitted and reviewed by pathology
for an in situ/epidermal component and it was found that the specimen was
dominated by a dermal mass measuring 4.8 3 3.9 3 3.7 cm. PET scan did not identify
any possible metastatic foci. The prognostic indicators, per CAP synoptic protocol
indicated a nodular melanoma by histology, with peripheral and deep margins
uninvolved by invasive melanoma, a mitotic rate of 6/mm2
, and no tumor regression,
microsatellitosis, lymph-vascular invasion, or lymph node involvement. Given the
clear excision margins, negative PET scan and that 0/42 lymph nodes were positive,
clinical observation going forward was eventually recommended. Primary dermal
melanoma is a diagnosis of exclusion. Dermatologists should consider PDM in the
differential diagnosis of patients with solitary cutaneous melanoma of unknown
origin. In this case, the diagnosis of PDM was arrived at after an initial pathology
diagnosis of primary nodular melanoma. Given that PDM is a distinct subtype of
melanoma characterized by improved survival, it is important to differentiate it from
PNM which it resembles histologically but carries a worse prognosis. PNM was
excluded because of a lack of overlying epidermal involvement, ulceration,
regression, negative node metastasis, and lack of evidence of distant metastasis. In
cases where the diagnosis is more ambiguous, recent studies suggest that additional
analysis through the means of immunohistochemistry can help differentiate PDM
from more aggressive variants.

Again, all of this limited research still suggests that the best approach is to consider this melanoma which means the treatment is still the same.

However, my husband’s was located in a place he got regularly burned for 20 years gardening, right near and he also had a weird skin flap on his body that regressed for several years and this happened to be the location the nodular bump arose. His primary physician told him it was nothing for about 10 year. But again, we can’t say specifically anything other than the pathology showed this was melanoma.

Marta, sounds like you are doing all the right things, so glad you are researching and requesting this information. This board is filled with great people who will share their knowledge and experience.

Many hugs and stay strong.