“…As it is well established that melanoma can initially present as a metastasis even in the absence of a recognized primary cutaneous tumor [41,42], and that metastasis from a known cutaneous melanoma can develop after a prolonged disease-free interval [43][44][45], we performed a detailed review of the patients' medical records (including, where appropriate, questioning the patients about their history of melanoma) to assure that the clinical history of the study cases was accurate.…”