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Living on the Edge

Diagnosing Sarcomatoid Melanoma Using Histopathologic Cues at the Edge of a Dedifferentiated Tumor

A Report of 2 Cases and Review of the Literature

Erstine, Emily M. MD, MBA*; Tetzlaff, Michael T. MD, PhD; Ko, Jennifer S. MD, PhD*; Prieto, Victor G. MD, PhD; Cheah, Alison L. MBBS; Billings, Steven D. MD*

The American Journal of Dermatopathology: August 2017 - Volume 39 - Issue 8 - p 593–598
doi: 10.1097/DAD.0000000000000716
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Abstract: Sarcomatoid melanoma is a rare type of melanoma lacking typical histologic features of melanoma and often lacks expression of S100 protein and melanocyte-specific markers. Given the rarity of this entity, its clinicopathologic findings are not well defined. We report 2 cases of sarcomatoid melanoma received in consultation: a 65-year-old woman with a right breast mass and a 62-year-old man with a left plantar heel mass. Both lesions were ulcerated, pedunculated, highly cellular proliferations of atypical spindle cells arranged as fascicles and/or sheets. The tumor cells of the breast mass expressed CD10 and vimentin diffusely but S100 protein only focally. The tumor cells of the heel mass lacked expression of melanocytic markers altogether, except for weak, very focal S100 protein expression. At the junctional edge of the breast mass and in the ulcer base of the heel mass, focal precursor melanoma was present and exhibited melanocytic differentiation. We report these cases to emphasize the importance of meticulous histologic inspection at the lesion's edge and/or ulcer base to correctly identify the conventional precursor melanoma in these rare lesions to ensure appropriate diagnosis and subsequent clinical management as treatment options may be significantly different from those offered for sarcomas.

*Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH;

Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and

Department of Histopathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia.

Reprints: Steven D. Billings, MD, Department of Pathology, Cleveland Clinic Foundation, 9500 Euclid Avenue/L2-266, Cleveland, OH 44195 (e-mail: billins@ccf.org).

The authors declare no conflicts of interest.

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