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 (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.
- Breslow's depth may not have as much prognostic value in PDM compared to classic melanoma. Long-term survival with PDM is much higher than for classic melanoma of similar depth.
- The DecisionDx-Melanoma assay is more likely to give a class I reading (low risk) for PDM compared to classic melanoma [JAAD 2014;71;1081].
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.
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%.
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