title: Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes.
abstract: BACKGROUND
  The presence of lymph node metastases in patients with malignant melanoma implies a significant decrease in survival. The authors investigated the efficacy of fine-needle aspiration biopsy (FNAB) in the diagnosis of metastatic malignant melanoma in 115 patients with melanoma and clinically suspicious regional lymph nodes.
  
  
  METHODS
  One hundred thirty-three FNABs were performed by cytopathologists after referral from surgeons or oncologists using a 25-gauge or 27-gauge needle.
  
  
  RESULTS
  The cytologic diagnosis was negative in 35, atypical in 1, suspicious in 2, and positive for malignant melanoma in 95. Regional lymph node dissections were performed in 78 patients. Of these, 70 positive FNABs were confirmed with no false-positive results. The atypical FNAB was proven positive for malignant melanoma at surgery. Of the two suspicious FNABs, one was confirmed as positive and one showed dermatopathic lymphadenopathy. Of the 35 negative FNAB specimens, 5 patients underwent surgery; 3 FNABs were found to be negative and 2 FNABS were falsely negative. Twenty patients with negative aspirates were followed clinically for 22-45 months (mean, 32 months); 19 patients had no evidence of disease and 1 patient died of disseminated melanoma.
  
  
  CONCLUSIONS
  FNAB of palpable lymphadenopathy in patients with malignant melanoma can provide a rapid and accurate assessment of lymph node status and expedite the therapeutic management of these patients.
authors.affiliation: Department of Pathology, New York University Medical Center, New York 10016, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cangiarella
authors.forename: W F
authors.initials: WF
authors.lastname: Symmans
authors.forename: R L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: D F
authors.initials: DF
authors.lastname: Roses
authors.forename: J M
authors.initials: JM
authors.lastname: Cohen
authors.forename: D
authors.initials: D
authors.lastname: Chhieng
authors.forename: M N
authors.initials: MN
authors.lastname: Harris
authors.forename: J
authors.initials: J
authors.lastname: Waisman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000379:methods; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000473:pathology*