Malignant melanoma diagnosed by fine-needle aspiration in cases presenting with parotid mass

BackgroundOne of the most common malignancies that metastasize to the parotid glands and associated lymph nodes is cutaneous melanoma. Although fine-needle aspiration (FNA) is well established for diagnosing primary salivary gland tumours, there is limited literature on its role in diagnosing metastatic lesions.Aims and ObjectivesThis study aims to investigate the cytomorphological features of malignant melanoma diagnosed by FNA in cases presenting with a parotid mass.Materials and MethodsWe present the clinical and cytomorphological findings of four cases. Conventional FNA biopsy smears and cell blocks were performed using standard techniques and for the differential diagnosis, a panel of immunohistochemical markers was used.ResultsThe patients included three females and one male, aged 54 to 77. FNA biopsies revealed atypical cells with large, hyperchromatic, pleomorphic nuclei, some of which exhibited prominent nucleoli. Plasmacytoid and oncocytic morphologies were also observed. Numerous mitotic figures were noted. Immunohistochemical staining showed HMB-45, S100 positivity in all cases. SOX10, MART-1 and MITF positivity were also observed. Three of the four patients had no history or suspected lesions of melanoma at the time of FNA diagnosis. The absence of melanin pigment complicated the diagnosis, but immunostains confirmed malignant melanoma.ConclusionDiagnosing malignant melanoma by FNA can be challenging, especially when the melanoma is in an unusual site, cytological findings are ambiguous, and there is no history of cutaneous melanoma. Accurate diagnosis requires a high level of suspicion and the use of appropriate immunohistochemistry. Herein, 4 cases of malignant melanoma, each presenting with a parotid mass and diagnosed by fine-needle aspiration, are presented. Diagnosis can be challenging when melanoma occurs in unusual sites, cytological findings are ambiguous, and there is no prior melanoma history. Accurate diagnosis requires high suspicion and suitable immunohistochemistry.image