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Management decisions for nodal metastasis from an unknown primary melanoma.

A 55 year-old man who was in otherwise good health, presented with a palpable mass in his right axilla. Because the mass failed to resolve with conservative measures, an excisional biopsy was performed. Immunocytochemical staining of the biopsy specimen with antibodies to S-100, HMB-45, and Melan-A revealed cells consistent with malignant melanoma. The patient denied a personal or family history of melanoma. Thirty years earlier, he had undergone excision of a suspicious lesion from his back, which proved to be a pathologically benign, compound nevus. The patient acknowledged considerable sun exposure throughout his life. Physical exam evaluation including exam