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Pini M. 1, Balice Y. 2, Tavecchio S. 2, Crippa D. 1
1 U.O.S.C. di Dermatologia, A.O. San Gerardo, Monza, Università degli Studi Milano Bicocca, Milano;
2 U.O. Dermatologia, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Milano
Desmoplastic melanoma is a rare subtype of melanoma that prevalently affects women and individuals over 55 years of age. It typically develops in sun-exposed skin of the head and neck region, and the face in particular. In the early stage, the lesions appear as lentiginous variegated macules or plaques, sometimes with small bluish-gray areas. In later stages, they may appear as dermal nodules. A peculiar characteristic of this variant of malignant melanoma is neutrotropism: fibroblast-like tumor cells found around or inside the endoneurium of skin nerves. Differential diagnosis includes hypertrophic scar, sarcoma, and dermatofibroma. Desmoplastic melanoma is often locally recurrent and metastasizes more often than lentigo malignant melanoma. Diagnosis requires examination by an expert dermatopathologist. Diagnosis is often late because the tumor’s appearance does not arouse suspicion and because its borders are irregular. Here we report the case of desmoplastic melanoma diagnosed late because of the apparently benign clinical presentation of a nodule on the patient’s left forearm.