Diagnosis of Metastatic Melanoma by Fine-Needle Biopsy

Abstract

Fine-needle biopsy (FNB) has been reported as a rapid, minimally invasive technique for the diagnosis of metastatic melanoma. The diagnostic accuracy of FNB was assessed in a consecutive series of 2,204 FNBs of clinically suspicious lesions from patients with previous primary melanomas treated at the Sydney Melanoma Unit, Sydney, Australia, between January 1992 and December 2002. The sensitivity and specificity of FNB were 96.3% and 98.9%, respectively. There were 5 false-positive cases (0.6%), which were verified as metastatic adenocarcinoma (3 cases) or reactive processes (organizing hematoma and chronic osteomyelitis, 1 each). False-negative diagnoses (6.7% of cases) were associated with a variety of clinicopathologic factors, including difficult-to-access anatomic sites (eg, high axilla or deep inguinal), small lesions, and lesional characteristics such asfibrosis, necrosis, or cystic change. FNB is a highly accurate, rapid, and cost-effective procedure for the diagnosis of metastatic melanoma and should be considered as the initial diagnostic procedure of choice in patients with melanoma with clinically suspected metastases.

Spindle Cell Melanoma: A Comparison of the Cytomorphological Features with the Epithelioid Variant

“…Melanomas can be readily diagnosed by cytomorphology alone since most of the cases present with typical features such as dispersed cell population of plasmacytoid to polygonal cells with intracytoplasmic melanin pigment, intranuclear inclusions and the presence of macronucleoli [7,8]. However, it is not unusual for this tumor to display divergent cellular morphology which frequently poses a diagnostic problem, especially if the clinical history is not suggestive or immunological markers are not available [3,5].…”

“…Spindle cell melanomas do not exhibit the classical features of melanoma and hence can be mistaken for a sarcomatous neoplasm when nuclear atypia is present or a benign soft tissue spindle cell tumor if the nuclear morphology is bland [5,8]. The presence of intracellular melanin pigment can be used as an important clue to the diagnosis which was present in approximately 80% of our cases.…”

A case of S-100 negative melanoma: A diagnostic pitfall in the workup of a poorly differentiated metastatic tumor of unknown origin

“…Although histologic examination of the surgical biopsies plays a major role in the diagnosis of primary cutaneous melanomas, FNAC is widely employed to confirm metastatic or recurrent lesions, with a sensitivity and specificity of 96.3% and 98.9%, respectively. [ 1 2 3 ] Despite the considerable current knowledge on the cytomorphology of melanoma, a cytologic diagnosis is often difficult, especially with amelanotic lesions. The hallmark cytomorphologic features include high cell - yield with a predominant population of dissociated cells with plasmacytoid, polygonal or spindle cells, nuclear pleomorphism, prominent nucleoli, intranuclear cytoplasmic inclusions, and a variable number of bi- and multinucleated cells.…”

“…Fine needle aspiration cytology (FNAC) with image guidance is the frontrunner in the evaluation of masses in the most common metastatic sites of the human body such as liver, lung, and lymph nodes. [ 1 2 3 ] A stepwise approach to the diagnosis of metastases of unknown primary tumor employs a combination of clinical context, morphology, immunohistochemistry (IHC), and molecular studies. [ 4 ]…”

Cytomorphologic Pitfall of Primary Malignant Melanoma of the Parotid Gland

“…1 Diagnosis of malignant melanoma, especially metastatic disease, is a common and cost-effective procedure. [6][7][8] In the study by Doubrovsky et al, 7 sensitivity in the diagnosis of metastatic melanoma was 92.1% and specificity was 99.2%.…”