Treatment of unknown primary melanoma

Article Abstract:

Malignant melanoma most often arises in the skin, often within a pre-existing mole. This form of cancer is particularly malignant, but fortunately its location in the skin makes it a good candidate for early detection and treatment. Melanomas arise from melanocytes, the normal skin cells that contain pigment and are responsible for skin color. A rather curious subset of malignant melanoma is the unknown primary melanoma. This is a melanoma that is not clearly a primary melanoma itself, since it occurs in places where melanocytes are not present. However, it is not clearly a metastatic melanoma either, since no primary melanoma is found in these cases. There are two prevailing theories that might explain the unknown primary melanoma. The first is that the primary melanoma has spontaneously regressed and is no long noticeable; the observed tumor is therefore a secondary metastatic cancer. In the other theory, the observed tumor has arisen from ectopic melanocytes, that is, melanocytes that are outside of their normal tissue location. Such ectopic cells are far from uncommon. The characteristics of 64 patients with unknown primary melanoma are reviewed. These cases were found among 1,045 melanoma patients seen over an 11-year period, indicating that unknown primary melanoma accounts for about 6 percent of all new cases of melanoma. The average age of the patients with unknown primary melanoma was 45 years. In 34 cases, only a single melanoma appeared to be present, and these patients enjoyed a 5-year survival rate of 45 percent. In contrast, the 5-year survival rate among the patients who had signs of more than one melanoma at the time of diagnosis was 10 percent. These survival statistics are roughly comparable with those of patients with known primary melanoma and similar stages of disease. The treatment of unknown primary melanoma should be the same as that of known primary melanoma, that is, radical surgical resection of the tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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Tumor thickness and prognosis in clinical Stage I malignant melanoma

Article Abstract:

Melanomas (cancerous moles) are currently staged, or classified according to severity, by one of two methods. The Clark method divides melanomas into five stages, according to the layer of skin involved. The Breslow method classifies melanomas according to their thickness, with the best survival associated with those which are below 0.76 millimeters (mm), and melanomas between 1.0 to 1.69 mm considered early with excellent prognosis, while those above 3.0 mm are designated thick melanomas. The thickness measurement provides a more accurate prognostication than the Clark technique. Several questions about the actual biology associated with changes in thickness remain, and the survival rate associated within the three thickness groups is not well-defined. To clarify these points, the five-year survival rates of patients with 1.0 to 15.0 mm melanomas has been evaluated. The survival rates of men and women were markedly different. Analysis of the data indicates that a 1.0 mm melanoma is associated with a 94 percent survival rate in women, and that this declines by 3 percent per mm increase in melanoma up to 6 mm, following which survival declines by 8 percent per mm. The five-year survival rate for men with a 1.0 mm melanoma is only 80 percent, with a decline of 9 percent in survival with each 1 mm increase in melanoma size, up to 10 mm. No breakpoints in the data were found, suggesting that there is no abrupt change in the biologic behavior of the tumor. The effect of sex on melanoma survival has been observed previously, but the mechanisms underlying the phenomenon are unknown. Further study is needed, particularly with respect to other factors which might influence survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Tumors

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Axillary node dissection in malignant melanoma

Article Abstract:

There is some disagreement regarding the benefit of removing lymph nodes in patients with malignant melanoma. Melanomas usually arise from skin cells, and contain melanocytes, cells that produce melanin, the black or brown pigment that occurs naturally in the skin, hair, and iris of the eye. The possible need for axillary (arm pit) lymph node dissection arises when melanoma is located in the arm or upper body. Following lymph node dissection, melanoma has a variable five-year survival rate. A report is presented of 212 patients with malignant melanoma who underwent axillary lymph node dissection; there were 261 operations performed (49 were repeat operations). Following surgery, there were 25 wound infections (10 percent). Also, arm edema (swelling) occurred in 10 patients, which resolved promptly and completely in six patients, but four patients had permanent moderate edema. For patients without evidence of cancer in the removed lymph nodes, the five-year survival was 74 percent. Patients with tissue studies that were positive for cancer, but did not have palpable nodes, had five-year survival of 73 percent. When nodes were palpable but small, less than 2 centimeters (cm), the five-year survival was 46 percent. Five-year survival for patients with nodes between 2 and 4 cm was 22 percent, and with nodes larger than 4 cm, 18 percent. If patients underwent additional surgery for cancer recurrence, about 13 percent remained disease-free for five years after the original surgery. This information suggests that survival is dependent upon early diagnosis and surgery, especially in patients with lymph node involvement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer metastasis, Lymph nodes, Lymph node excision

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