title: Melanoma patients with unknown primary site or nodal recurrence after initial diagnosis have a favourable survival compared to those with synchronous lymph node metastasis and primary tumour.
abstract: BACKGROUND
  A direct comparison of prognosis between patients with regional lymph node metastases (LNM) detected synchronously with the primary melanoma (primary LNM), patients who developed their first LNM subsequently (secondary LNM) and those with initial LNM in melanoma with unknown primary site (MUP) is missing thus far.
  
  
  METHODS
  Survival of 498 patients was calculated from the time point of the first macroscopic LNM using Kaplan Meier and multivariate Cox hazard regression analysis.
  
  
  RESULTS
  Patients with secondary LNM (HR = 0.67; p = 0.009) and those with initial LNM in MUP (HR = 0.45; p = 0.008) had a better prognosis compared to patients with primary LNM (median survival time 52 and 65 vs. 24 months, respectively). A high number of involved nodes, the presence of in-transit/satellite metastases and male gender had an additional independent unfavourable effect.
  
  
  CONCLUSIONS
  Survival of patients with LNM in MUP and with secondary LNM is similar and considerably more favourable compared to those with primary LNM. This difference needs to be considered during patient counselling and for stratification purposes in clinical trials. The assumption of an immune privilege of patients with MUP which is responsible for rejection of the primary melanoma, and results in a favourable prognosis is not supported by our data.
authors.affiliation: Center for Dermatooncology, Department of Dermatology, University Medical Center, Tuebingen, Germany. benjamin.weide@med.uni-tuebingen.de
authors.forename: Benjamin
authors.initials: B
authors.lastname: Weide
authors.forename: Christine
authors.initials: C
authors.lastname: Faller
authors.forename: Margrit
authors.initials: M
authors.lastname: Elsässer
authors.forename: Petra
authors.initials: P
authors.lastname: Büttner
authors.forename: Annette
authors.initials: A
authors.lastname: Pflugfelder
authors.forename: Ulrike
authors.initials: U
authors.lastname: Leiter
authors.forename: Thomas Kurt
authors.initials: TK
authors.lastname: Eigentler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bauer
authors.forename: Friedegund
authors.initials: F
authors.lastname: Meier
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000556:secondary*; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D016019:Survival Analysis