Aspiration biopsy and the clinical management of patients with malignant melanoma and palpable regional lymph nodes

BACKGROUND. The presence of lymph node metastases in patients with malignan t melanoma implies a significant decrease in survival. The authors investig ated the efficacy of fine-needle aspiration biopsy (FNAB) in the diagnosis of metastatic malignant melanoma in 115 patients with melanoma and clinical ly 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 ne edle. RESULTS. The cytologic diagnosis was negative in 35, atypical in 1, suspici ous in 2, and positive for malignant melanoma in 95. Regional lymph node di ssections were performed in 78 patients. Of these, 70 positive FNABs were c onfirmed with no false-positive results. The atypical FNAB was proven posit ive 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 fou nd to be negative and 2 FNABS were falsely negative. Twenty patients with n egative aspirates were followed clinically for 22-45 months (mean, 32 month s); 19 patients had no evidence of disease and 1 patient died of disseminat ed melanoma. CONCLUSIONS. FNAB of palpable lymphadenopathy in patients with malignant me lanoma can provide a rapid and accurate assessment of lymph node status and expedite the therapeutic management of these patients. (C) 2000 American C ancer Society.