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: SUMMARY Background: Melanomas that initially affect lymph nodes, with no identified primary lesion, have traditionally been included within the group of metastatic melanomas of unknown origin (MMUO).There are variations between the various data presented in the literature. Its natural history is not well defined and there are no clear guidelines for treat- ment. The aim of our work is to review the cases that have been monitored in the Gipuzkoa Oncological Institute (GOI) for more than 8 years, in order to gain a perspective with regard to survival, and to present those findings that may be of interest. Material and Methods: A study of the histories of patients coded as having MMUO in the Tumour Registry of the GOI from 1980 to1999. Results: Following strict inclusion criteria, we found 8 cases of MMUO (1.52% of 523 total melanomas), of which 3 women correspond to melanomas initially affecting a lymph node (0.57%). Case 1: Thirty-year-old, supraclavicular location. Case 2: Thirty- one-year-old, intramammary node. Case 3: Fifty-eight-year- old, inguinal adenopathy. A radical cervical lymphadenec- tomy; local removal with mammary extension and resection of a relapsed adenopathy; and local resection of the inguinal adenopathy respectively were done. All 3 patients are free of disease after a follow-up period of more than 20 years, with no chemotherapy treatment. Conclusions: While the group of cases is small, the findings raise the possibility that the- re may be a subgroup of melanomas, up to now considered as MMUO, that are true primary lymph node tumours with favourable biological development different to the normal evolution for reasons that have not yet been established. They should not be considered as Stage III or IV of mela- noma and could be treated on an individual basis, with local surgery alone.
Chapter: Histopathologie des Melanoms12/2005: pages 139-156;
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ABSTRACT: The natural history of metastatic melanoma in lymph nodes in the absence of a known primary site (MUP) has been defined poorly; thus, treatment guidelines for patients with MUP are not clear-cut. The authors conducted a retrospective analysis of consecutive patients with melanoma (from 1990 to 2001) who underwent surgical resection for melanoma metastatic to regional lymph nodes. Among those patients, 71 patients with MUP and 466 control patients who had regional lymph node metastases of similar stage with a known primary site were identified. Associations between clinicopathologic factors and survival were estimated by using the Cox proportional hazards model. After they underwent lymph node dissection, patients with MUP were classified with N1b disease (47%), N2b disease (14%), or N3 disease (39%). With a median follow-up of 7.7 years, the 5-year and 10-year overall survival rates were 55% and 44%, respectively, for patients with MUP, compared with 42% and 32%, respectively, for the control group (P = .04). In multivariate analyses, age 50 years or older, male gender, and N2b or N3 disease status were identified as adverse prognostic factors, and MUP was identified as a favorable prognostic factor (hazard ratio, 0.61; 95% confidence interval, 0.42-0.86; P = .006) for overall survival. The relatively favorable long-term survival of patients with MUP in the current study suggested that patients with MUP have a natural history that is similar to (if not better than) the survival of many patients with Stage III disease. Therefore, patients with MUP should be treated with an aggressive surgical approach with curative intent and should be considered for Stage III adjuvant therapy protocols. Cancer 2006. (c) 2006 American Cancer Society.Cancer 05/2006; 106(9):2012-20. DOI:10.1002/cncr.21835 · 4.90 Impact Factor