Patterns of the first lymph node metastases in patients with cutaneous malignant melanoma of axial localization

At the Finsen Institute, Copenhagen, from 1971 to 1981, 134 patients were treated for lymph node metastases from primary cutaneous malignant melanoma of axial localization (e.g., in the head and neck and trunk), where metastases to regional lymph node groups were the first sign of dissemination. Due to the lack of sufficient clinical data, 27 patients were excluded from the study. Median time from excision of primary tumor to diagnosis of node metastases was 11 months. In 42 of 85 (49%) patients with truncal melanoma, the primary tumor was placed in the lymphatic water-shed areas. Two patients among this group showed bilateral simultaneous metastases to two different node groups. In the remaining 43 patients with truncal tumors located outside water-shed areas, node metastases developed in unexpected groups in seven (16%) patients. Of 22 patients with head and neck tumors, two (9%) patients demonstrated metastases to distant lymph node groups without metastases to the regional node basins.