Pathology and FollowUp

All three lymph nodes were free of disease by H&E and immunohistochemistry staining (HMB-45, S-100). Six months later, the patient came to the clinic because he felt a lump in the neck. A 1-cm rubbery node was palpated in the right supraclavicular fossa. Fine-needle aspiration cytology revealed melanoma cells. A radical right neck dissection was performed after a search for other sites of disease (including computed tomography scans of chest, neck, and brain; liver ultrasound; bone scintigraphy; blood chemistry) revealed no other tumor locations. Two supraclavicular nodes contained melanoma deposits; the other 28 nodes in the specimen were free of disease. A distant skin metastasis was discovered 9 months later. The patient died from brain metastases 1 year after the neck dissection.

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