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Answer 4
  1. Fine-needle biopsy of the lesion. Approximately 15% of all discovered adrenal incidentalomas that are removed are malignant.3 The risk of malignancy increases with increasing tumor size. Given the patient’s history of melanoma, CT results showing an enhanced nodule, and normal biochemical screening profile, fine-needle biopsy is the next best step in the evaluation. MRI would not provide additional information in this case. In the absence of biochemical evidence suggesting pheochromocytoma, MIBG is not likely to be helpful.

    3. Favia G, Lumachi F, Basso S, D'Amico DF. Management of incidentally discovered adrenal masses and risk of malignancy. Surgery 2000;128:918-24.

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