Melanoma patients with unknown primary site or nodal recurrence after initial diagnosis have a favourable survival compared to those with synchronous lymph node metastasis and primary tumour

• Published in: PloS one Vol. 8; no. 6; p. e66953
• Main Authors: Weide, Benjamin, Faller, Christine, Elsässer, Margrit, Büttner, Petra, Pflugfelder, Annette, Leiter, Ulrike, Eigentler, Thomas Kurt, Bauer, Jürgen, Meier, Friedegund, Garbe, Claus
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.06.2013; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Biopsy; Cancer metastasis; Clinical trials; Committees; Comparative analysis; Confidence intervals; Dermatology; Female; Health surveillance; Histopathology; Humans; Immune privilege; Lymph; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Male; Medical diagnosis; Medical prognosis; Medical research; Medicine; Melanoma; Melanoma - diagnosis; Melanoma - secondary; Metastases; Metastasis; Middle Aged; Neoplasms, Unknown Primary - pathology; Patient outcomes; Patients; Prognosis; Public health; Recurrence; Regression analysis; Skin cancer; Skin Neoplasms - diagnosis; Skin Neoplasms - secondary; Survival; Survival Analysis; Tumors; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0066953

A direct comparison of prognosis between patients with regional lymph node metastases (LNM) detected synchronously with the primary melanoma (primary LNM), patients who developed their first LNM subsequently (secondary LNM) and those with initial LNM in melanoma with unknown primary site (MUP) is missing thus far. Survival of 498 patients was calculated from the time point of the first macroscopic LNM using Kaplan Meier and multivariate Cox hazard regression analysis. Patients with secondary LNM (HR = 0.67; p = 0.009) and those with initial LNM in MUP (HR = 0.45; p = 0.008) had a better prognosis compared to patients with primary LNM (median survival time 52 and 65 vs. 24 months, respectively). A high number of involved nodes, the presence of in-transit/satellite metastases and male gender had an additional independent unfavourable effect. Survival of patients with LNM in MUP and with secondary LNM is similar and considerably more favourable compared to those with primary LNM. This difference needs to be considered during patient counselling and for stratification purposes in clinical trials. The assumption of an immune privilege of patients with MUP which is responsible for rejection of the primary melanoma, and results in a favourable prognosis is not supported by our data.