Unknown Primary Melanoma: Worldwide Survey on Clinical Management

How to deal with melanoma of unknown primary (MUP) origin is a debated topic in the literature.

We performed a worldwide survey to inquire what clinical and investigational workup is performed as well as the physicians' perception of this disease.

A questionnaire was sent via mail to clinicians involved in melanoma care from December 2015 to April 2016 using the International Dermoscopy Society website.

119 physicians from 47 different countries answered the questionnaire. The most reported examination was skin examination followed by CT and/or PET scans. All the participants declared asking about previous excisions of skin lesions with 81% of them asking for a histopathological slide review of previous biopsies. Half of the participants checked for a possible vitiligo phenomenon that may explain regression of the primary lesion. BRAF, cKIT, and GNAQ mutations were screened by 32% of participants. The majority of participants (76%) applied the same treatment protocols for MUP as patients with known primary melanomas of the same AJCC stage.

Strong heterogeneity was found between physicians dealing with MUP. Thus, a consensus document should be strongly encouraged.