Figure 15. Case 5: (A) A right femur biopsy demonstrates sheets of melanin-laden macrophages surrounding cancellous bone (hematoxylin and eosin [H&E], original magnification ×40). (B) On higher magnification, scattered hyperchromatic, histologically viable melanoma tumor cells are present in a background of necrosis and melanin pigment (H&E, ×320). (C) A concurrent lung biopsy shows vaguely spindle shaped melanoma tumor cells with intranuclear pseudo-inclusions (H&E, ×400). (D) Low magnification a subsequent axillary lymph node resection specimen demonstrates lymph node profiles largely replaced by metastatic melanoma (H&E, ×5). (E) Necrosis (left portion of image) and melanin pigment (right portion of image) are present (H&E, ×200). (F) A subsequent small bowel resection demonstrates metastatic melanoma with a vaguely spindle cell pattern (H&E, ×200).