Melanoma of unknown primary: experience at Massachusetts General Hospital and Dana-Farber Cancer Institute.
ABSTRACT Melanoma may present metastatically without an identifiable primary lesion. To further characterize the epidemiology of melanoma of unknown primary (MUP), we report our experience with a cohort of MUP patients. We retrospectively reviewed patients seen at the Massachusetts General Hospital (MGH) and the Dana-Farber Cancer Institute (DFCI) between 1986 and 1996 with follow-up to 2002. Data were analysed using log-rank and proportional hazards analyses, with death from any cause as the main outcome measure. Of the 2485 melanoma patients seen, 65 (2.6%) had MUP; 41 patients were male [63.1%; 95% confidence interval (CI), 50.2%, 74.7%]. The median age at diagnosis was 54.1 years (interquartile range, 39.4-67.1 years). Thirty patients had lymph node metastases, 12 cutaneous or subcutaneous metastases and 23 visceral metastases. Of the 62 patients (95.4%) with at least some follow-up, there were 42 deaths from any cause. Patients with lymph node metastases survived significantly longer than patients with other metastases [5-year survival 38.7% (95% CI, 18.1%, 59.1%) vs. 13.9% (95% CI, 4.4%, 28.6%); P<0.01]. After adjusting for stage and age at diagnosis, there was some evidence that men survived longer than women [hazard ratio (HR)=0.55; 95% CI, 0.28, 1.09]. Survival did not differ amongst patients with different types of non-lymph node metastases. The 5-year survival rates in this cohort did not differ from those of historical controls with known primaries. The demographic and survival characteristics of this MUP cohort mirrored those found in previous studies. More studies of MUP patients, as well as a standardized definition of MUP, may shed light on the pathogenesis and prognosis of MUP.
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ABSTRACT: Metastatic melanoma from an unknown primary (MUP) is rare; its occurrence in the gastrointestinal tract is of exceedingly low prevalence. We report a case of a 73-year-old man with metastatic malignant melanoma to the colon from an unknown primary. The rarity of MUP and importance of screening for gastrointestinal metastasis in patients with malignant melanoma are discussed along with the role of surgical resection in improving prognosis and overall survival.Case reports in gastrointestinal medicine. 01/2014; 2014:312902.
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ABSTRACT: In 3% of melanomas, the primary tumor is occult. We report a 58 years old female presenting with rapidly growing painless left inguinal lymphadenopathies. The patient was reassessed two months later, verifying that the lesions enlarged further. A CAT scan of the left inguinal region showed a solid mass in the subcutaneous of the proximal region of the left thigh. An incisional biopsy of the inguinal mass was performed. The pathological study disclosed malignant melanoma. The patient was subjected to an iliofemoral lymphatic excision and to five sessions of regional radiotherapy. After two years of follow up, the patient is without evidence of tumor recurrence.Revista chilena de cirugía. 04/2012; 64(2):180-184.
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ABSTRACT: To compare outcomes of patients with clinical nodal melanoma metastases that occurred without a detectable primary tumor (melanoma of unknown primary site; MUP) with those with a known primary site (KPM). We included data from 459 consecutive patients treated from 1994 to 2007 with radical therapeutic lymph node dissection (LND; stage IIIB, C) due to clinically palpable and pathologically confirmed lymph node metastases (229 axillary; 230 ilioinguinal). The median follow-up was 49 months. LND was performed in 59 cases (12.9%; 29 men, 30 women) due to MUP nodal metastases, including 33 axillary (14.4%) and 26 ilioinguinal (11.3%). In the MUP group, the 3- and 5-year survival rates were 48% and 41%, respectively. Similar rates were observed in patients with KPM, even with matched-pair analyses. Established prognostic factors (number of metastatic nodes, p=.005; extracapsular extension of metastases, p=.002) influenced survival in the MUP group. Relapses occurred in 31 (53%) and 299 (74.7%) cases in the MUP and KPM groups, respectively. Survival rates in the MUP and KPM groups were similar, and the same prognostic factors affected both. Thus, all MUP cases should be treated as standard stage III melanomas.Dermatologic Surgery 06/2010; 36(6):868-76. · 1.87 Impact Factor