Prognosis of Mucosal, Uveal, Acral, Nonacral Cutaneous, and Unknown Primary Melanoma From the Time of First Metastasis.
Subtypes of melanoma, such as mucosal, uveal, and acral, are believed to result in worse prognoses than nonacral cutaneous melanoma. After a diagnosis of distant metastatic disease, however, the overall survival of patients with mucosal, uveal, acral, nonacral cutaneous, and unknown primary melanoma has not been directly compared.



We conducted a single-center, retrospective analysis of 3,454 patients with melanoma diagnosed with distant metastases from 2000 to 2013, identified from a prospectively maintained database. We examined melanoma subtype, date of diagnosis of distant metastases, age at diagnosis of metastasis, gender, and site of melanoma metastases.



Of the 3,454 patients (237 with mucosal, 286 with uveal, 2,292 with nonacral cutaneous, 105 with acral cutaneous, and 534 with unknown primary melanoma), 2,594 died. The median follow-up was 46.1 months. The median overall survival for those with mucosal, uveal, acral, nonacral cutaneous, and unknown primary melanoma was 9.1, 13.4, 11.4, 11.7, and 10.4 months, respectively. Patients with uveal melanoma, cutaneous melanoma (acral and nonacral), and unknown primary melanoma had similar survival, but patients with mucosal melanoma had worse survival. Patients diagnosed with metastatic melanoma in 2006-2010 and 2011-2013 had better overall survival than patients diagnosed in 2000-2005. In a multivariate model, patients with mucosal melanoma had inferior overall survival compared with patients with the other four subtypes.



Additional research and advocacy are needed for patients with mucosal melanoma because of their shorter overall survival in the metastatic setting. Despite distinct tumor biology, the survival was similar for those with metastatic uveal melanoma, acral, nonacral cutaneous, and unknown primary melanoma.



Uveal, acral, and mucosal melanoma are assumed to result in a worse prognosis than nonacral cutaneous melanoma or unknown primary melanoma. No studies, however, have been conducted assessing the overall survival of patients with these melanoma subtypes starting at the time of distant metastatic disease. The present study found that patients with uveal, acral, nonacral cutaneous, and unknown primary melanoma have similar overall survival after distant metastases have been diagnosed. These findings provide information for oncologists to reconsider previously held assumptions and appropriately counsel patients. Patients with mucosal melanoma have worse overall survival and are thus a group in need of specific research and advocacy.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Deborah
D
Kuk
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA.
Alexander N
AN
Shoushtari
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Christopher A
CA
Barker
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Katherine S
KS
Panageas
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Rodrigo R
RR
Munhoz
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA.
Parisa
P
Momtaz
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Charlotte E
CE
Ariyan
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Mary Sue
MS
Brady
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Daniel G
DG
Coit
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Kita
K
Bogatch
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA.
Margaret K
MK
Callahan
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA.
Jedd D
JD
Wolchok
Columbia University College of Physicians and Surgeons, New York, New York, USA.
Richard D
RD
Carvajal
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, New York, New York, USA postowm@mskcc.org.
Michael A
MA
Postow
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000556:secondary; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality*; D014604:Uveal Neoplasms / Q000401:mortality*; D055815:Young Adult; D000098943:Uveal Melanoma
Acral cutaneous melanoma; Mucosal melanoma; Nonacral cutaneous melanoma; Prognosis; Unknown primary melanoma; Uveal melanoma