Balloon cell melanoma: a systematic review

Abstract

Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review of the clinical, dermoscopic, and histological features among BCM cases reported in the literature. A systematic review of all case reports and series published since 1970 was conducted via MEDLINE, Embase, and Web of Science, using "balloon cell melanoma" and synonymous search terms. Our systematic search identified 76 cases (49% male, 51% female) of BCM in the literature. The mean age at presentation was 57.81 years. Prior skin cancer, particularly melanoma (47%), accounted for 58% of pertinent medical history.Prominent clinical exam findings included raised (46%), ulcerated (73%) lesions larger than 1 cm (68%) in the lower extremities (35%). Median Breslow thickness of primary BCM cases was 2.5 mm. Hairpin vessels (75%) and structureless architecture (75%) were predominant on dermoscopy. Notable histopathology included large (47%), vacuolated (58%) cells with foamy cytoplasm (62%) and conspicuous nucleoli (27%). Positive S-100 immunohistochemistry (73%) was most frequently employed to diagnose BCM. We observed 47% primary and 53% metastatic BCM cases. Of metastatic BCMs, balloon cells in the primary lesion were unknown in 48%, devoid in 33%, and present in 20% of cases.All metastases displayed predominant balloon cell morphology. BCM may represent an advanced phase in the progression of malignant melanoma. Improved awareness of BCM characteristics among clinicians may reduce the risk of misdiagnoses.

Balloon Cell Malignant Melanoma: A Case Report

“…The tumor cells of BCMM exhibit nuclear pleomorphism, atypia and presence of mitotic figures. 1,6,7 The nuclei of tumor cells of BCMM are irregularly placed and nuclear chromatin are irregularly clumped. 1,7 And although not common, the presence of necrosis support the diagnosis of melanoma.…”

“…1,6,7 The nuclei of tumor cells of BCMM are irregularly placed and nuclear chromatin are irregularly clumped. 1,7 And although not common, the presence of necrosis support the diagnosis of melanoma. 6 Cytoplasm of tumor cells of BCMM is vacuolated or vesiculated.…”

“…6 Cytoplasm of tumor cells of BCMM is vacuolated or vesiculated. 7 BCMM cells are generally non-pigmented and lack melanin. 7,8 Also the melanocytes in BCMM lack maturity on descent in the dermis.…”

“…7 BCMM cells are generally non-pigmented and lack melanin. 7,8 Also the melanocytes in BCMM lack maturity on descent in the dermis. 6 In contrast the cells in BCN have centrally located nuclei and exhibits no nuclear pleomorphism and mitotic activity.…”

An Unusual Case of Primary Gastric Balloon Cell Melanoma

“…BCM is a unique histopathological subtype seen in less than 1% of malignant melanoma. 10 The prognosis of BCM depends on the Breslow depth, not cytological characteristics, although BCM may infer an advanced phase of the malignant melanoma.…”