Desmoplastic Melanoma

A minute, nonpigmented, innocuous-appearing papule on the nose of a 60-year-old man did not seem cause for alarm. However, a simple, 3-mm punch biopsy saved this patient's life. The second photo shows the extent of this rare, histologically proven desmoplastic melanoma, Clark's level V. Writes Dr Paul B. Thompson of Sequim, Wash: "If I had said, 'Oh, it doesn't look bad, I don't think you need to worry about it,' by the time I saw him again, it definitely would have been too late!"

Desmoplastic malignant melanoma is an unusual variant of malignant melanoma and is often difficult to diagnose. Because of its relative rarity, it has not been well studied, and questions remain concerning its biologic potential. Factors correlated with survival include tumor site, depth of invasion, and the patient's gender. The 5-year disease-free survival rate is approximately 60%.

This patient underwent excision of the tumor with wide margins, the resulting defect encompassing his entire right lateral nasal wall, the medial cheek, the medial aspect of his lower eyelid, and the dorsum of his nose. Following surgery, reconstruction was undertaken with a full-thickness skin graft harvested from his right posterior auricular sulcus. Subsequently, the patient underwent adjunctive hypofractionated radiotherapy. He is alive and healthy 1 year after the original diagnosis was established.