Balloon cell melanoma: a case report with polarized and non-polarized dermatoscopy and dermatopathology

Abstract

Balloon cell melanoma is a rare melanoma subtype, with only one previous case with dermatoscopy published. It is often non-pigmented, leading to diagnostic difficulty, and there is a tendency for lesions to be thick at diagnosis.We report a case of balloon cell melanoma on the forearm of a 61-year-old man with both polarized and non-polarized dermatoscopy and dermatopathology. It presented as a firm pale nodule with focal eccentric pigmentation. The clinical images evoke a differential diagnosis of dermatofibroma, dermal nevus, Spitz nevus and basal cell carcinoma as well as melanoma. This melanoma was partially pigmented due to a small, pigmented superficial spreading component on the edge of the non-pigmented balloon cell nodule, prompting further evaluation. In retrospect there was the clue to malignancy of polarizing-specific white lines (chrysalis structures) and polymorphous vessels, including a pattern of dot vessels. The reticular lines exclude basal cell carcinoma, polarizing-specific white lines are inconsistent with the diagnosis of dermal nevus and their eccentric location is inconsistent with both Spitz nevus and dermatofibroma. Excision biopsy was performed, revealing a superficial spreading melanoma with two distinct invasive components, one of atypical non-mature epithelioid cells and the other an amelanotic nodular component, comprising more than 50% of the lesion, characterized by markedly distended epithelioid melanocytes showing pseudo-xanthomatous cytoplasmic balloon cell morphology. A diagnosis of balloon cell melanoma, Breslow thickness 1.9 mm, mitotic rate 3 per square millimeter was rendered. Wide local excision was performed, as was sentinel lymph node biopsy, which was negative.

Non-choroidal yellow melanoma showing positive staining with Sudan Black consistent with the presence of lipofuscin: a case report

“…Considering the possibility that it may actually have been the balloon cells that caused the yellow color, the only other reported BSM with dermatoscopic images was a partially pigmented lesion with a dominant structureless white area and without any yellow color [13]. The case we report here did have two cell populations, including one with large cells with vacuolated cytoplasm resembling balloon cells (Figures 6 A, C, D), but it did not meet the criteria for diagnosis as a BCM which requires that the melanoma contain more than 50% of balloon cells, [14] and in fact the sheets of balloon cells were only present focally.…”

“…Structureless dermatoscopic yellow color has also been attributed to ulceration with surface serum exudate [ 6 ], and dermatoscopic structureless yellow color was described in the first case report of a balloon cell melanoma (BCM) with dermatoscopy [ 12 ], being attributed by the authors to ulceration. Considering the possibility that it may actually have been the balloon cells that caused the yellow color, the only other reported BSM with dermatoscopic images was a partially pigmented lesion with a dominant structureless white area and without any yellow color [ 13 ]. The case we report here did have two cell populations, including one with large cells with vacuolated cytoplasm resembling balloon cells ( Figures 6 A, C, D ), but it did not meet the criteria for diagnosis as a BCM which requires that the melanoma contain more than 50% of balloon cells, [ 14 ] and in fact the sheets of balloon cells were only present focally.…”

Bizarre Pigmented Lesion on the Scalp: A Quiz

“…In a review of 34 patients, 2 cases were 19-year-olds and no information on the date of onset was provided, so the existence of balloon cell melanoma in the paediatric age group cannot be excluded (8). Dermatoscopy of balloon cell melanoma has been described in 2 adult cases only, revealing a central structureless white area with a rim of structureless brown and pigmented reticular lines and linear/dotted vessels in 1 case (9), and structureless yellow areas, ulceration and curved/dotted vessels in the other (10); interestingly, no white or yellow globules were observed in either case.…”

Balloon Cell Melanoma: Presentation of Four Cases with a Comprehensive Review of the Literature

“…In this context, balloon cell melanoma (BCM), is a fairly rare, bizarre entity that can sometimes manifest not only in a context of melanoma metastases but also as a primary lesion [ 6 ]. Over time, different explanations have been proposed to justify the morphological changes, but ultimately, the best accepted view (also thanks to electron microscopy studies and acquisitions) is that an overproduction of swollen and defective melanosomes is at the origin of this morphotype [ 7 ]. In this paper, we present four cases of balloon cell melanoma, discuss their main differential diagnoses and perform an extensive review of the current literature in order to trace the state of the art and future prospects.…”