Pigmented Atypical Fibroxanthoma, a Dermatofibroma Variant?

Melanoma associated with a dermatofibroma

BACKGROUND

Dermatofibromas are common benign cutaneous fibrohistiocytic neoplasms, whereas melanomas are potentially aggressive malignancies. Differentiating these two entities can occasionally be difficult.

METHODS

We report the case of a 56-year-old female presenting with a firm pink papule on the left thigh.

RESULTS

Histopathology revealed atypical melanocytes in the epidermis and papillary dermis with numerous mitotic figures and intraepidermal pagetoid spread. Within the dermis was a poorly demarcated collection of epithelioid and spindled cells with intermixed keloidal collagen. The atypical melanocytes stained for MART-1 and S-100, whereas the underlying fibrohistiocytic tumor took up factor XIIIa immunostain, confirming the diagnosis of invasive malignant melanoma occurring in association with a dermatofibroma.

CONCLUSIONS

This case emphasizes the role of immunohistochemical stains in correctly diagnosing melanocytic and histiocytic neoplasms.