title: Metastatic melanoma with an unknown primary.
abstract: An infrequent initial presentation for malignant melanoma is the diagnosis of metastatic disease without a history of an obvious primary lesion. Confusion exists in the literature concerning the workup, treatment, and prognosis of the unknown primary melanoma. A retrospective, computer-aided chart review of 580 consecutively registered patients with melanoma at the University Treatment Center (Tampa, FL), identified 18 patients with an unknown primary presentation. There were 10 males and 8 females with a mean age of 38.4 years. Ninety-four percent of the patients were diagnosed with metastatic disease in a nodal basin, whereas 1 patient had a resected isolated lung mass as the initial presentation. In the patients who presented after having a biopsy of a single positive node for diagnosis, more disease was recovered in the nodal basin with a formal node dissection in 59% of the patients. Actuarial survival curves were constructed for the group with unknown primary melanoma. As a control population, survival curves were constructed of the subpopulation of patients with melanoma who had a known primary and had stage III (regional nodal disease) at diagnosis. There was no difference in survival between those with known and unknown primary melanoma (p = 0.96).
authors.affiliation: Division of General Surgery, H. Lee Moffitt Cancer Center, Tampa, FL 33682-0179.
authors.forename: J
authors.initials: J
authors.lastname: Norman
authors.forename: C W
authors.initials: CW
authors.lastname: Cruse
authors.forename: K E
authors.initials: KE
authors.lastname: Wells
authors.forename: H I
authors.initials: HI
authors.lastname: Saba
authors.forename: D S
authors.initials: DS
authors.lastname: Reintgen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005431:Florida / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D008197:Lymph Node Excision / Q000592:standards; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D010044:Outpatient Clinics, Hospital; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate