PRIMARY DERMAL MELANOMA

This inconspicuous red dermal papule on the upper chest turned out, on biopsy, to be a primary dermal melanoma.
Primary dermal melanoma


Primary dermal melanoma (PDM) is a rare variant of melanoma confined to the dermis without an epidermal component [JAAD 2014;71;1083]. Differentiation of PDM from metastatic melanoma is critical, but often hard to do. The other possibility is classic melanoma with regression of the epidermal component.

Clinical

The PDM may occur anywhere on the skin. Lesions may be black, brown, blue, pink, white, or skin-colored. The clinical diagnosis at the time of biopsy has included melanoma, nevus, BCC, SCC, dermatofibroma, cyst neurofibroma, and scar. Male and female patients are equally likely.

Treatment

Wide surgical excision should be done. Sentinel node biopsy is often performed along with PET/CT scan or other workup for metastatic disease. For true PDM, 5-year survival has been reported at 80-100%.

Additional Pictures

Primary dermal melanoma

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