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A Benign Condition That Mimics Metastatic Melanoma

LCDR Russell A. Ball, MC, USN; David Genest, MD; Maureen Sander, MD; Birgitta Schmidt, MD; Raymond L. Barnhill, MD

Arch Dermatol. 1998;134:711-714.

Background  Placental metastases from cutaneous malignant melanoma from both the mother and the fetus have been reported. The finding of benign-appearing melanocytes in the placenta in association with congenital melanocytic nevi (CMN) is more exceptional, with only 6 reports in the literature. Clinically, the finding of melanocytes in the placenta in this setting can be alarming and might erroneously lead to the diagnosis of metastatic melanoma.

Observations  Herein, we describe 3 additional patients with CMN with placental infiltration by melanocytes with a benign phenotype. In the results of immunoperoxidase stains, the melanocytic cells were positive for S-100 protein and HMB-45 in the 2 lesions available for study. Staining of placental vessels with Ulex europaeus agglutinin I (Vector Laboratories, Burlingame, Calif) failed to show intravascular melanocytes in the 1 lesion available for study. We report for the first time DNA diploidy in 2 lesions available for study, which were analyzed by DNA image cytometry. We describe the first patient with a relatively small, nongiant CMN.

Conclusions  We support the notion of the aberrant migration of melanocytes from the neural crest during fetal development as the most likely explanation of this phenomenon and note the similarity to the association of CMN and leptomeningeal melanocytosis. However, the precise histogenesis of this process remains uncertain. Most importantly, our data provide further evidence for the benign nature of this condition. Awareness of this entity is of vital importance in avoiding overdiagnosis of melanoma in this clinical setting.

From the Division of Dermatopathology (Dr Ball) and the Department of Pathology (Drs Genest and Barnhill), Harvard Medical School, the Department of Pathology, Carney Hospital (Dr Schmidt), and the Division of Dermatopathology, Brigham and Women's Hospital, Children's Hospital, and Harvard Community Health Plan (Dr Barnhill), Boston, Mass; and the Department of Pathology, Michigan State University, East Lansing (Dr Sander). Dr Barnhill is now with the Division of Dermatopathology and Oral Pathology, The Johns Hopkins Medical Institutions, Baltimore, Md.

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