Metastatic melanoma, or is it?

A case of pigmented axillary nodes in the presence of malignant melanoma of the upper extremity points out the caution necessary in making intraoperative decisions based on gross appearance at the time of surgery. Had our preoperative plans been abandoned in consideration of the "obvious pathology," the patient might not have done as well. Histologic confirmation should always precede any altering of preoperative plans despite gross findings.