Metastatic melanoma to kidney
History of removal of melanoma forehead with multiple recurrences. Now presents with flank pain.
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Tumours such as this, with no morphological clues to indicate the cell lineage, are often initially labelled as 'malignant spindled cell tumour'; examples of what a pathologist looks for include residual gland, mucin or keratin production (poorly differentiated carcinoma), melanin pigmentation (melanoma) or specific mesenchymal differentiation (eg rhabdomyoblasts, lipoblasts etc). When these morphological clues are not present, we attempt to uncover residual protein expression (immunohistochemistry), utilise cytogenetic profiling, or sometimes even resort to ultrastructural morphology (electron microscopy). In this case the immunohistochemical tests confirmed metastatic melanoma.