Annals of Surgical Oncology

, Volume 22, Issue 2, pp 475–481 | Cite as

In-transit Melanoma Metastases: Incidence, Prognosis, and the Role of Lymphadenectomy

  • Rebecca L. Read
  • Lauren Haydu
  • Robyn P. M. Saw
  • Michael J. Quinn
  • Kerwin Shannon
  • Andrew J. Spillane
  • Jonathan R. Stretch
  • Richard A. Scolyer
  • John F. Thompson
Melanomas

Abstract

Purpose

To analyze a large, single-institution database to further understanding of melanoma in-transit metastases (ITM) with regard to incidence, prognosis, and the role of lymphadenectomy.

Methods

A total of 11,614 patients with single primary cutaneous melanomas were treated at Melanoma Institute Australia between January 1994 and December 2009. Of these, 505 developed ITM. Clinicopathologic characteristics, sentinel node (SN) status, patterns of disease progression, and outcomes were analyzed.

Results

In the 505 patients with ITM, the median primary tumor thickness was 2.95 mm, and 39.4 % were ulcerated. The ITM rates for patients with primary melanomas <1 or ≥1 mm in size and in those who underwent sentinel node biopsy were 0.4, 7.8, and 7.2 %, respectively. The ITM rates for SN-positive and SN-negative patients were 21.6 and 4.7 %, respectively. The median time from primary diagnosis to the development of ITM was 17.9 months. After ITM diagnosis, the median survival time was 19.9 months, 5-year survival was 32.8 %, and 10-year survival was 27.5 %. After ITM diagnosis, primary tumor site (head/neck, trunk) and ulceration were predictors of poorer survival. Five-year survival from the time of ITM ranged from 47.9 % for nonulcerated limb primary lesions to only 13.6 % for ulcerated trunk primary lesions. Elective lymph node dissection in clinically node-negative patients with ITM did not significantly alter overall survival.

Conclusions

This large study demonstrates that the diagnosis of melanoma ITM carries serious adverse prognostic implications and will assist in improving the accuracy of staging and prognostic estimates as well as treatment in these patients.

Keywords

Melanoma Sentinel Node Primary Melanoma Regional Node Metastasis Breslow Thickness 

Notes

Acknowledgment

We thank Kaye Oakley for her assistance with the preparation of the article; we also gratefully acknowledge assistance from MIA colleagues. This study was supported by Melanoma Institute Australia, the Cancer Institute New South Wales, the National Health & Medical Research Council, and the Melanoma Foundation of the University of Sydney.

Disclosure

The author’s have no conflict of interest or financial disclosures.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Rebecca L. Read
    • 1
    • 2
  • Lauren Haydu
    • 1
  • Robyn P. M. Saw
    • 1
    • 2
    • 3
  • Michael J. Quinn
    • 1
    • 2
    • 3
  • Kerwin Shannon
    • 1
    • 2
    • 3
  • Andrew J. Spillane
    • 1
    • 2
    • 3
  • Jonathan R. Stretch
    • 1
    • 2
    • 3
  • Richard A. Scolyer
    • 1
    • 2
    • 4
  • John F. Thompson
    • 1
    • 2
    • 3
  1. 1.Melanoma Institute AustraliaSydneyAustralia
  2. 2.Royal Prince Alfred HospitalSydneyAustralia
  3. 3.Discipline of Surgery, Sydney Medical SchoolThe University of SydneySydneyAustralia
  4. 4.Discipline of Pathology, Sydney Medical SchoolThe University of SydneySydneyAustralia

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