Schlagenhauff B, Stroebel W, Ellwanger U, Meier F, Zimmermann C, Breuninger H, Rassner G, Garbe C
Department of Dermatology, Eberhard-Karls-University, Tuebingen, Germany.
Cancer. 1997 Jul 1;80(1):60-5. doi: 10.1002/(sici)1097-0142(19970701)80:1<60::aid-cncr8>3.0.co;2-j.
Metastatic melanoma of unknown primary origin accounts for approximately 2-6% of all melanoma cases. The prognostic significance of this diagnosis is still controversial.
Of 3258 patients with malignant melanoma recorded during the period 1976-1996, 2.3% had metastases of unknown primary origin. Anatomic distribution, clinical stage, and survival probabilities were evaluated.
Thirty patients were classified as having cutaneous or subcutaneous in-transit metastases, and they showed a 5-year survival rate of 83%. Thirty-seven patients were classified as having lymph node metastasis, and their 5-year survival rate was 50%. Disseminated disease was diagnosed in only 8 patients, who had a median survival of 6 months. Comparison of survival probabilities for patients with in-transit metastases and unknown primary tumors with the probabilities for those with cutaneous primary tumors revealed a significant advantage for the former group. No significant differences were found for patients with lymph node metastasis when those with unknown primary tumors were compared with those who had cutaneous melanomas with regional lymph node metastasis.
The clinical disease course of patients with metastatic melanoma of unknown primary origin is similar to that of patients with primary cutaneous melanoma when the same clinical stages of the disease are compared. Based on the assumption that the majority of regional metastases develop from completely regressed primary cutaneous melanoma, recommendations for initial staging examinations in patients with unknown primary tumors are given in this article.
原发灶不明的转移性黑色素瘤约占所有黑色素瘤病例的2% - 6%。这一诊断的预后意义仍存在争议。
在1976 - 1996年期间记录的3258例恶性黑色素瘤患者中，2.3%有原发灶不明的转移。评估了解剖分布、临床分期和生存概率。
30例患者被分类为有皮肤或皮下移行转移，其5年生存率为83%。37例患者被分类为有淋巴结转移，其5年生存率为50%。仅8例患者被诊断为播散性疾病，其中位生存期为6个月。将有移行转移和原发灶不明肿瘤患者的生存概率与有皮肤原发性肿瘤患者的概率进行比较，结果显示前一组有显著优势。当将原发灶不明肿瘤患者与有区域淋巴结转移的皮肤黑色素瘤患者进行比较时，发现有淋巴结转移的患者之间无显著差异。
当比较相同临床分期的疾病时，原发灶不明的转移性黑色素瘤患者的临床病程与原发性皮肤黑色素瘤患者相似。基于大多数区域转移来自完全消退的原发性皮肤黑色素瘤这一假设，本文给出了对原发灶不明肿瘤患者进行初始分期检查的建议。
