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Abstract:
Of 230 melanoma patients treated during the past 8 years, 12 (5.2%) were found to have unknown primary lesions. Nine of these "unknown primary melanoma' patients presented with metastases in regional lymph nodes, one inside the parotid gland, and two presented with disseminated melanoma and no detectable primary tumor. The patients with melanoma confined to a regional lymph node underwent block dissection followed by adjuvant chemotherapy and immunotherapy. Four patients with metastasis in only one lymph node are disease free 4-6 years after diagnosis. One patient with multiple metastases in the groin is alive 8 years after lymphadenectomy. The other five patients with metastases in multiple regional lymph node died 16 months to 3 years after surgery. Both patients with disseminated melanoma succumbed to their disease within a month of diagnosis. The prognosis of unknown primary melanoma seems to be no worse than the typical melanoma at the same stage. This justifies the aggressive surgical approach to this unusual entity of melanoma.
Insights
Unknown primary melanoma, while rare, has a prognosis similar to typical melanoma. Aggressive surgical treatment for regional lymph node metastasis shows promising long-term survival for some patients.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- Melanoma of unknown primary (MUP) is a rare clinical presentation.
- Identifying MUP is crucial for appropriate staging and treatment.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of patients with unknown primary melanoma.
- To assess the efficacy of aggressive surgical management for MUP.
Main Methods:
- Retrospective review of 230 melanoma patients over 8 years.
- Analysis of 12 patients diagnosed with unknown primary melanoma.
- Surgical management (lymphadenectomy) followed by adjuvant therapy for regional lymph node metastasis.
Main Results:
- 5.2% of melanoma patients had unknown primary lesions.
- Nine patients presented with regional lymph node metastasis, one with parotid gland involvement, and two with disseminated disease.
- Four patients with single lymph node metastasis remain disease-free 4-6 years post-treatment.
- One patient with multiple groin metastases survived 8 years post-surgery.
- Five patients with multiple regional lymph node metastases died within 16 months to 3 years.
- Both patients with disseminated MUP died within one month.
Conclusions:
- Unknown primary melanoma prognosis appears comparable to melanoma of known primary at similar stages.
- Aggressive surgical intervention, including lymphadenectomy, is warranted for MUP with regional lymph node metastasis.
- Further research into optimal adjuvant therapies for MUP is indicated.