The distinction between metastatic amelanotic melanoma
and a poorly differentiated carcinoma is often difficult.
With the use of the ultrastructural L-DOPA reaction as a
tool for measuring tyrosinase activity within vesicular and
cisternal organelles, cells containing melanin can be
identified. Our study identified a tumor which was classified
by light microscopy as an undifferentiated carcinoma
and by electron microscopy as an undifferentiated neoplasm.
Nine parameters were evaluated: a nude mouse xenograft,
the patient's tumor cells in agar with and without L-DOPA
treatment, and single cell suspensions of the patient's
tumor cells with and without L-DOPA treatment. As controls,
cells from Cloudman S91 (CCL) 53.1 melanoma, grown into
colonies in agar with and without L-DOPA treatment and in
single cell suspensions with and without L-DOPA treatment,
were evaluated. The xenograft demonstrates no melanosomes.
Cells in single cell suspensions with L-DOPA treatment and
patient cells grown into colonies in agar with and without
L-DOPA treatment contain granular dense bodies within the
cytoplasm, suggestive of melanosomes. Premelanosomes (Stage
II), Golgi, and Golgi-associated smooth endoplasmic reticulum
contain DOPA-positive reaction product when cultured in
the agar assay. A DOPA-positive reaction is also noted in
the Golgi-associated smooth endoplasmic reticulum of the
single cell suspensions. The CCL line demonstrates premelanosomes
in all cases. These. findings unequivocally
identify the tumor as amelanotic melanoma and indicate that
identification of DOPA-positive cells grown into colonies
in agar are essential for diagnosis. These parameters may
be applied to ambiguous cases of malignancy for which
amelanotic melanoma is suspected. (Supported in part by
grants from NIH (T32 CA09213 to B.P.) and ACS (PDT-184 to
F.L.M. and PDT-205 to M.J.C.H.)