Isolated Perfusion of Extremities for Metastatic Melanoma From an Unknown Primary Lesion

Jh, Muchmore; Et, Krementz; Rd, Carter; Cm, Sutherland; Ea, Mendoza

doi:10.1097/00007611-198603000-00007

Cited by 9 publications

(6 citation statements)

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“…Expectedly, survival in MUP patients differs significantly by lymph node, subcutaneous nodule, and visceral involvement at initial presentation . Estimates of OS time in MUP patients who present with lymph node metastases range from 30 to 127 months (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies use the full diagnostic criteria set forth by Das Gupta to define MUP . In a systematic review, Kamposioras et al reported that only 16% of published peer‐reviewed studies of MUP used the original Das Gupta criteria to define cases of unknown primaries.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

“…Patients with MUP most commonly present with nodal disease, including axillary, cervical, and inguinal lymph nodes and the parotid gland . Patients can also present with subcutaneous nodules or visceral or bony metastases . Regional lymph node disease represents about 40%‐60% of cases in most studies, although one study reported that only 28% of patients presented with disease limited to regional lymph nodes and the majority of patients had evidence of concurrent distant metastases .…”

Section: Metastasis Sites and Stagingmentioning

confidence: 99%

“…Complete regression is much less common but has been documented to occur . Among patients diagnosed with MUP, 5% to 34% provide a history suggestive of regressed skin lesions …”

Section: Etiologymentioning

confidence: 99%

“…Patients with nodal MUP typically undergo lymph node dissection as the standard of care, including parotidectomy if the parotid gland is involved . Studies have shown that patients with nodal MUP had better outcomes when they underwent prompt lymph node dissection .…”

Section: Treatmentmentioning

confidence: 99%

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Melanoma of unknown primary

Song

Karakousis

2018

Journal of Surgical Oncology

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Formally described in the 1960s, melanoma of unknown primary (MUP) is characterized by the finding of metastatic melanoma within the lymph nodes, subcutaneous tissues, and other distant sites without an evident primary lesion. The most likely hypothesis of its etiology is an immune-mediated regression of the primary after metastasis has occurred.In addition, patients with MUP appear to have equivalent or better outcomes compared with patients with known primaries of a similar stage. K E Y W O R D S malignant melanoma, melanoma occult primary, melanoma regression, unknown primary 1 | INTRODUCTION Melanoma incidence has increased steadily over the last three decades. Over 90 000 new cases are estimated to be diagnosed in the year 2018 in the United States. 1 The vast majority of cases are cutaneous melanoma, but melanoma can also occur in extracutaneous locations, such as the eyes or mucous membranes. 2 Although more than 90% of cases are comprised of melanomas with a known primary site (MKP), occasionally it is discovered first as a secondary deposit within lymph nodes, subcutaneous tissues, or other organs without a clearly evident site of origin. The first diagnosis of melanoma of unknown primary (MUP) dates back to 1917. 3 Pack et al 3 described a series of 1,190 patients treated at Memorial Hospital between 1917 and 1950, of which 29 (2.4%) patients were classified as having an occult primary. Compared with other patients with melanoma, patients diagnosed with MUP were initially reported to have especially poor outcomes. While the overall 5-year recurrence-free survival was 21.4%, only one patient with MUP was cured. The authors wrote that "the patient defies all laws and expectations by continuing to live" 14 years after initial axillary dissection for lymph node metastasis. Das Gupta 4 formally described the entity of MUP in 1963. His proposed diagnostic criteria excluded patients who had any of the following: a history of orbital exenteration or enucleation; a history of excision or removal of any mole, birthmark, freckle, chronic paronychia, or skin blemish; scar in the skin drained by the nodal basin containing metastatic melanoma; and an incomplete physical examination, which also included ophthalmoscopy and examination of the anus and genitalia. 2 | DIAGNOSTIC CRITERIA Few studies use the full diagnostic criteria set forth by Das Gupta to define MUP. 5-10 In a systematic review, Kamposioras et al 11 reported that only 16% of published peer-reviewed studies of MUP used the original Das Gupta criteria to define cases of unknown primaries. The majority of studies make the diagnosis of MUP based on history, physical examination, pathology, and imaging, resulting in heterogeneity and variations in how MUP is defined. Studies typically vary in the completeness of physical examination required and the exclusion of patients with previously existing skin lesions. For example, Wong et al and Katz et al 12,13 defined patients as having MUP only if they had a documented thorough skin examination and did not have an...

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Section: Discussionmentioning

confidence: 99%

Section: Diagnostic Criteriamentioning

confidence: 99%

Section: Metastasis Sites and Stagingmentioning

confidence: 99%

“…Complete regression is much less common but has been documented to occur . Among patients diagnosed with MUP, 5% to 34% provide a history suggestive of regressed skin lesions …”

Section: Etiologymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

See 3 more Smart Citations

Melanoma of unknown primary

Song

Karakousis

2018

Journal of Surgical Oncology

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Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases

Guarischi

Keane

Elhakim

1987

Cancer

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Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.

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Treatment of unknown primary melanoma

Velez

Walsh

Karakousis

1991

Cancer

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Sixty‐four patients with unknown primary melanoma were identified among 1045 new patients with melanoma (6%) seen during an 11‐year period. Their mean age was 44.5 years (median age, 42.7 years). Of these, 39 (59%) were men, and 25 (38%) were women. In 34, only one site was involved. Common single sites were the axilla (29%), groin (24%), and neck (32%). Most of the melanomas (88%) were melanotic. Patients with localized melanoma surgically treated (n = 34) had a median survival of 53 months, and a 5‐year survival rate of 45%. The respective rates for disseminated melanoma were 7 months and 10% (P = 0.00001). Localized, unknown primary melanoma should be treated with radical excision because a substantial proportion of patients so treated survive 5 years. Cancer 68:2579–2581, 1991.

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Isolated Perfusion of Extremities for Metastatic Melanoma From an Unknown Primary Lesion

Cited by 9 publications

References 0 publications

Melanoma of unknown primary

Melanoma of unknown primary

Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases

Treatment of unknown primary melanoma

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