Objectives: Fine-needle aspiration cytology serves as a rapid and cost-effective tool for the diagnosis of melanoma, especially in the recurrent and metastatic cases. The diagnosis poses a challenge due to the varied morphological patterns. Spindle cell melanoma mimics other sarcomas and carcinomas on morphology. This study highlights the cytomorphological features of spindle cell melanoma and compares them with the conventional epithelioid type. Study Design: Cytology smears of 55 aspirates from 45 diagnosed cases of melanoma from various sites were reviewed. Histopathology correlation was done in spindle and mixed cell tumors. Results: Melanomas with a pure or mixed spindle cell component occurred in 31% of the cases and in a slightly higher age group. These demonstrated prominent cellular cohesion (p < 0.0001), mild to moderate nuclear atypia and inconspicuous to small nucleoli as compared to the epithelioid variant. The presence of melanin pigment was a useful clue to the diagnosis. Most of the cases correlated well with the histomorphology. Conclusion: Spindle cell melanoma is a morphological variant which can be readily misinterpreted due to a lack of classical cytological features of melanoma. Hence, these are vulnerable to be misinterpreted as other neoplasms. An awareness of clinical and cytological features is important to reach the correct diagnosis.

Keywords:
Spindle cell melanoma, Cytology, Metastasis
1.
Leong SP, Gershenwald JE, Soong SJ, Schadendorf D, Tarhini AA, Agarwala S, Hauschild A, Soon CW, Daud A, Kashani-Sabet M: Cutaneous melanoma: a model to study cancer metastasis. J Surg Oncol 2011;103:538-549.
2.
Schmid-Wendtner MH, Baumert J, Schmidt M, Konz B, Hölzel D, Plewig G, Volkenandt M: Late metastases of cutaneous melanoma: an analysis of 31 patients. J Am Acad Dermatol 2000;43:605-609.
3.
Banerjee SS, Harris M: Morphological and immunophenotypic variations in malignant melanoma. Histopathology 2000;36:387-402.
4.
Saqi A, McGrath CM, Skovronsky D, Yu GH: Cytomorphologic features of fine-needle aspiration of metastatic and recurrent melanoma. Diagn Cytopathol 2002;27:286-290.
5.
Piao Y, Guo M, Gong Y: Diagnostic challenges of metastatic spindle cell melanoma on fine needle aspiration specimens. Cancer Cytopathol 2008;114:94-101.
6.
Nasiell K, Tani E, Skoog L: Fine needle aspiration cytology and immunocytochemistry of metastatic melanoma. Cytopathology 1991;2:137-147.
7.
Gupta SK, Rajwanshi AK, Das DK: Fine needle aspiration cytology smear patterns of malignant melanoma. Acta Cytol 1985;29:983-988.
8.
Murali R, Doubrovsky A, Watson GF, McKenzie PR, Lee CS, McLeod DJ, Uren RF, Stretch JR, Saw RP, Thompson JF, Scolyer RA: Diagnosis of metastatic melanoma by fine-needle biopsy: analysis of 2,204 cases. Am J Clin Pathol 2007;127:385-397.
9.
de Almeida LS, Requena L, Rütten A, Kutzner H, Garbe C, Pestana D, Gomes MM: Desmoplastic malignant melanoma: a clinicopathologic analysis of 113 cases. Am J Dermatopathol 2008;30:207-215.
10.
Yamada T, Itou U, Watanabe Y, Oashi S: Cytologic diagnosis of malignant melanoma. Acta Cytol 1972;16:70-76.
11.
Layfield LJ, Ostrzega N: Fine needle aspirate smear morphology in metastatic melanoma. Acta Cytol 1989;33:606-612.
12.
Kline TS, Kannan V: Aspiration biopsy cytology and melanoma. Am J Clin Pathol 1982;77:597-601.
13.
Murali R, Loughman NT, McKenzie PR, Watson GF, Thompson JF, Scolyer RA: Cytologic features of metastatic and recurrent melanoma in patients with primary cutaneous desmoplastic melanoma. Am J Clin Pathol 2008;130:715-723.
14.
Friedman M, Forgione H, Shanbhag V: Needle aspiration of metastatic melanoma. Acta Cytol 1980;24:7-15.
15.
Perry MD, Gore M, Seigler HF, Johnston WW: Fine needle aspiration biopsy of metastatic melanoma. A morphologic analysis of 174 cases. Acta Cytol 1986;30:385-396.
16.
Woyke S, Domagala W, Czerniak B, Strokowska M: Fine needle aspiration cytology of malignant melanoma of the skin. Acta Cytol 1980;24:529-538.
17.
Kapila K, Kharbanda K, Verma K: Cytomorphology of metastatic melanoma - use of S-100 protein in the diagnosis of amelanotic melanoma. Cytopathology 1991;2:229-237.
18.
Kobayashi G, Cobb C: A case of amelanotic spindle-cell melanoma presenting as metastases to breast and axillary lymph node: diagnosis by FNA cytology. Diagn Cytopathol 2000;22:246-249.
19.
Marco V, Sirvent J, Alvarez Moro J, Clavel M, Muntal MT, Bauza A: Malignant melanotic schwannoma fine-needle aspiration biopsy findings. Diagn Cytopathol 1998;18:284-286.
20.
Bruijn JA, Mihm MC Jr, Barnhill RL: Desmoplastic melanoma. Histopathology 1992;20:197-205.
21.
Magro CM, Crowson AN, Mihm MC: Unusual variants of malignant melanoma. Mod Pathol 2006;19(suppl 2):S41-S70.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.