[Melanoma metastasis in the neck region with unknown primary tumor]

In 4-8% of all melanoma patients, a lymph node metastasis develops as the first manifestation of the disease, whereas a primary lesion cannot be found. The latter may have been surgically removed already years ago, may be located at an occult place or - as it is especially characteristic for melanoma - may have vanished spontaneously due to a specific immunological mechanism. Such spontaneous tumour regression, which, for instance, becomes recognisable by the development of a halonaevus or an asymmetrical vitiligo, does not imply an improvement of the individual prognosis. However, present knowledge suggests that in patients with unknown primary lesion neither an adjuvant chemotherapy nor immunotherapy can be recommended, if the metastasis has been surgically removed completely. Additional radiotherapy does also not appear to be indicated. Only a short-interval follow-up remains important.