title: The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients.
abstract: We examined whether mucosal melanomas are different in their clinical course and patterns of metastases when arising from different anatomic sites. Our hypothesis was that metastatic behavior would differ from primary mucosal melanomas at different anatomical sites.
  
  
  
  Clinical and pathological data from 706 patients were compared for their stage distribution, patterns of metastases, CKIT/BRAF mutation status, and overall survival for different anatomical sites.
  
  
  
  The anatomic sites of the primary mucosal melanomas were from the lower GI tract (26.5%), nasal cavity and paranasal sinuses (23%), gynecological sites (22.5%), oral cavity (15%), urological sites (5%), upper GI tract (5%), and other sites (3.0%). At initial diagnosis, 14.5% were stage I disease, 41% Stage II, 21.5% Stage III, and 23.0% stage IV. Predominant metastatic sites were regional lymph nodes (21.5%), lung (21%), liver (18.5%), and distant nodes (9%). Oral cavity mucosal melanoma had a higher incidence of regional nodal metastases (31.7% versus 19.8%, P = 0.009), and a higher incidence of lung metastases (32.5% versus 18.5%, P = 0.007) compared to other primary mucosal melanomas. There was a 10% incidence of CKIT mutation and 12% BRAF mutation. Mucosal melanomas from nasal pharyngeal and oral, gastrointestinal, gynecological, and urological had a similar survival with a 1-year survival rate (88%, 83%, 86%), 2-year survival rate (66%, 57%, 61%), 5-year survival rate (27%, 16%, 20%), respectively.
  
  
  
  The largest sample size allows, for the first time, a comparison of primary melanoma stage and patterns of metastases across anatomical sites. With few exceptions, the presenting stages, incidence of nodal and distant metastases, the site of predilection of distant metastases, or overall survival were similar despite different primary anatomic sites. These findings suggest that clinical trials involving mucosal melanomas and the administration of systemic therapy can be applied equally to mucosal melanomas regardless of their primary anatomic site.
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: B
authors.initials: B
authors.lastname: Lian
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: C L
authors.initials: CL
authors.lastname: Cui
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Melanoma, Yunnan Cancer Hospital, Kunming, China.
authors.forename: X
authors.initials: X
authors.lastname: Song
authors.affiliation: Department of Melanoma, SUN YAT-SEN University Cancer Center, Guangzhou, China.
authors.forename: X S
authors.initials: XS
authors.lastname: Zhang
authors.affiliation: Department of Melanoma, The First Hospital of Jilin University, Changchun, China.
authors.forename: D
authors.initials: D
authors.lastname: Wu
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: L
authors.initials: L
authors.lastname: Si
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: Z H
authors.initials: ZH
authors.lastname: Chi
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: X N
authors.initials: XN
authors.lastname: Sheng
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: L L
authors.initials: LL
authors.lastname: Mao
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: B X
authors.initials: BX
authors.lastname: Tang
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: X Q
authors.initials: XQ
authors.lastname: Yan
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Kong
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: S M
authors.initials: SM
authors.lastname: Li
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Bai
authors.affiliation: Clinical Pharmacology Research Centre, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: N
authors.initials: N
authors.lastname: Zheng
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Balch
authors.affiliation: Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D009362:Neoplasm Metastasis / Q000473:pathology*
keywords: mucosal melanoma; natural history; overall survival; patterns of metastases