Circulating amelanotic melanoma cells. (A) Wright-Giemsa stain of peripheral blood smear shows large pleomorphic cells with abundant cytoplasm, eccentric nuclei, and marked anisokaryosis. (B) Paraffin-embedded liver tissue was stained with melanomaspecific HMB-45 monoclonal antibody. Numerous melanoma cells are found in hepatic sinusoids and hepatic veins without significant extravasation. (C) Bone marrow biopsy stained with HMB-45 illustrates the significant reduction of hematopoiesis and the dense infiltration by melanoma cells.