title: Metastatic patterns and metastatic sites in mucosal melanoma: a retrospective study.
abstract: OBJECTIVE
  Melanomas arising from mucosa are rare and associated with a poor prognosis. This study aims to provide an analysis of metastatic pathways, time intervals, factors influencing metastatic spread and organs for distant metastases.
  
  
  METHODS
  A total of 116 patients with mucosal melanomas of different sites were included. The mean follow-up interval was 47 ± 52 months. Patients were assigned to two different metastatic pathways, either presenting loco-regional lymph node metastases as first spread or direct distant metastases. The distribution of distant metastases was assessed.
  
  
  RESULTS
  Twenty-six patients presented with a pre-existing metastatic spread and were not assigned to pathways. Of the included patients, 44 developed metastases after treatment of the primary tumour; 25 patients directly developed distant metastases; 16 patients developed regional lymph node metastases prior to distant metastases. Location of the primary tumour in the upper airway or GI tract and advanced T stage were significant risk factors of direct distant metastases. Distant metastases are mainly located in the lung, the liver and non-regional lymph nodes.
  
  
  CONCLUSIONS
  Mucosal melanomas show a high rate of direct distant metastases rather than regional lymph node metastases. Thus the follow-up should always include a whole-body cross-sectional imaging in high-risk tumours.
  
  
  CONCLUSIONS
  • Mucosal melanomas show a high rate of direct distant metastases. • T stage and primary location are predictors for direct distant metastases. • Distant metastases were mainly found in lung, liver and lymph nodes. • Follow-up of a high-risk mucosal melanoma should include whole-body imaging.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany. gerd.groezinger@med.uni-tuebingen.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Grözinger
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany.
authors.forename: Steven
authors.initials: S
authors.lastname: Mann
authors.affiliation: Department of Dermatology, University hospital Tübingen, Liebermeisterstraße 25, 72076, Tübingen, Germany.
authors.forename: Tarun
authors.initials: T
authors.lastname: Mehra
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Klumpp
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grosse
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Department of Dermatology, University hospital Tübingen, Liebermeisterstraße 25, 72076, Tübingen, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.affiliation: Department of Diagnostic and Interventional Radiology, University hospital Tübingen, Hoppe- Seylerstr. 3, 72076, Tübingen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Clasen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009092:Mucous Membrane; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Imaging; Metastatic pathway; Metastatic spread; Mucosal melanoma; Progression