title: Metastatic mucosal melanoma: imaging patterns of metastasis and recurrence.
abstract: OBJECTIVE
  Mucosal melanoma is a rare but aggressive subtype of melanoma with unique clinicopathologic features. We hypothesize that mucosal melanoma shows predilection for separate and unique metastatic pathways.
  
  
  METHODS
  This was a retrospective analysis of 19 patients (5 men and 14 women; median age 60 years, range 38-76 years) with metastatic mucosal melanoma presenting to a tertiary oncology center between 2005 and 2010. We performed a review of medical records and histologic and imaging studies to evaluate the natural history, metastatic patterns and the role of imaging in the management of patients with advanced mucosal melanoma.
  
  
  RESULTS
  At presentation, disease was confined to the primary site (58%, n = 11) or to the regional lymph nodes (32%, n = 6) in most patients. The most common site of metastasis was the lungs (89%, n = 16), followed by the liver (67%, n = 12) and peritoneum (44%, n = 8). Sinonasal melanoma preferentially spread to the liver (100%, n = 4), vaginal melanoma to the lungs (100%, n = 7) and anal melanoma to the inguinal lymph nodes (100%, n = 4).
  
  
  CONCLUSIONS
  Pathways of metastatic spread in mucosal melanoma may differ from other forms of melanoma and between different primary sites of mucosal origin.
authors.affiliation: Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Regan
authors.affiliation: Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
authors.forename: Micheál
authors.initials: M
authors.lastname: Breen
authors.affiliation: Department of Imaging.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Ramaiya
authors.affiliation: Department of Imaging.
authors.forename: Jyothi
authors.initials: J
authors.lastname: Jagannathan
authors.affiliation: Department of Imaging.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: DiPiro
authors.affiliation: Department of Cutaneous Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA.
authors.forename: F Stephen
authors.initials: FS
authors.lastname: Hodi
authors.affiliation: Department of Imaging.
authors.forename: Annick D
authors.initials: AD
authors.lastname: Van den Abbeele
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D064847:Multimodal Imaging / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed