Giant cutaneous melanomas: evidence for primary tumour induced dormancy in metastatic sites?

Abstract

Two patients with giant, 8 cm and 19 cm melanomas of the upper extremity, respectively, are presented and discussed. Both patients had neglected their tumours and sought medical attention only after the appearance of distressing symptoms (for example, bleeding). Palpable lymph nodes were found on physical examination but no evidence of distant metastases was noted on imaging studies despite such enormous primary tumours. Both patients underwent aggressive treatment, including complete surgical resection of the primary tumour and ipsilateral axillary lymph node dissection. One patient had no evidence of local recurrence, but developed metastatic disease at 6 months follow-up. The other patient developed local recurrence and distant metastases within 2 months of resection.

Reconstruction of the natural history of metastatic cancer and assessment of the effects of surgery: Gompertzian growth of the primary tumor

“…Thus, according to the model, resection of the primary tumor in patients A and B led to a dramatic increase in the rate of growth of bone metastases. This conclusion is supported by clinical reports on sudden exacerbation of metastatic disease following surgery in patients with testicular, skin, pancreatic and lung cancers as well as osteosarcoma [9][10][11][12][13][14].…”

“…In the case of logistic growth of the primary tumor our model is parameterized by A; M; h; q; l; d, where A and M are given in (11), h and q have the same meaning as above, and…”

“…In this case pdf p underlying the distribution of site-specific volumes of metastases can be computed in terms of parameters A and M defined in (11) and parameters a ¼ kh c 0…”

Patient with giant upper limb melanoma presenting to a UK plastic surgery unit: differentials and experience of management

“…Other authors, including Tseng et al ,7 highlight that distant spread can happen quickly after surgical resection, therefore careful follow-up is paramount.…”

Seeing the Invisible: How Mathematical Models Uncover Tumor Dormancy, Reconstruct the Natural History of Cancer, and Assess the Effects of Treatment

“…(b) Excision of primary melanomas precipitated metastatic spread of the disease in three skin cancer patients [ 35,36 ] . (c) In one case of pancreatic cancer, excision of the primary adenocarcinoma (via the Whipple procedure) caused surfacing of numerous previously undetectable liver metastases within 34 days of the surgery [ 37 ] .…”