Primary Localization and Tumor Thickness as Prognostic Factors of Survival in Patients with Mucosal Melanoma

Mehra, Tarun; Grözinger, Gerd; Mann, Steven; Guenova, Emmanuella; Moos, Rudolf; Röcken, Martin; Claussen, Claus D.; Dummer, Reinhard; Clasen, Stephan; Naumann, Aline; Garbe, Claus

doi:10.1371/journal.pone.0112535

Cited by 23 publications

(13 citation statements)

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“…In our study 64% of the patients died during follow-up, the 5-year survival rate was 26.3%, which is slightly lower than indicated in the literature with 5-year survival rates of 32.4%, [22] 34%, [15] and up to 55.8%. [23] …”

Section: Discussionmentioning

confidence: 99%

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Clinics, prognosis and new therapeutic options in patients with mucosal melanoma

2017

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Mucosal melanomas represent a rare entity with different risk factors and molecular features compared to cutaneous melanomas. They arise most commonly from mucosal surfaces in the head/neck region, the female genital tract (FGT) and the anorectal region. The aim of this study was to evaluate clinics, prognosis, and treatment options of patients with mucosal melanoma, in particular with regard to different primary sites.We retrospectively analyzed 75 patients with mucosal melanomas diagnosed in the years 1993 to 2015 in our department. The primary melanomas were located in the head/neck region (n = 32), the FGT (n = 24), and the anorectal region (n = 19).The median age of the patients was 66 years. At initial diagnosis the primary melanoma was not completely resectable in 11 (15%) patients, 18 (24%) patients had regional lymph node metastases, and 7 (9%) patients distant metastases. During follow-up, 22 (29%) patients suffered from a local recurrence, in particular patients with primary melanoma in the head/neck region without postoperative radiotherapy. By multivariate analysis location of the primary melanoma in the head/neck area or anorectal region and presence of metastases at time of diagnosis represented poor prognostic factors for recurrence-free survival. In 62 tested individuals 7 KIT mutations were found, 2 BRAF mutations in 57 tested patients. Four patients received targeted therapies, 14 checkpoint inhibitors, 4 (1/1 on vemurafenib, 1/7 on ipilimumab, and 2/7 on PD-1 inhibitors) patients showed responses of more than 100 days duration.Mucosal melanomas are often locally advanced or metastatic at initial diagnosis, thus they require extensive staging procedures. The high rate of local recurrences in the head/neck region can be significantly reduced by postoperative radiotherapy. For the potential use of medical treatment a mutation analysis for KIT and BRAF genes should be performed. The use of new immunologic and targeted therapies has to be further evaluated.

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Section: Discussionmentioning

confidence: 99%

“…Mehra et al [23] could also show a better prognosis for vulvar melanomas in comparison to other localizations of the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

Clinics, prognosis and new therapeutic options in patients with mucosal melanoma

2017

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“…It is generally believed that melanoma arising from a mucosal, uveal, or acral cutaneous primary location portends a worse overall prognosis than melanoma arising from a nonacral cutaneous primary location. This assumption has largely been based on studies that have reported high recurrence rates after definitive treatment of primary mucosal, uveal, and acral melanoma and poor overall survival from the time of the diagnosis of primary disease to death [9][10][11][12][13][14]. Despite these prognostic assumptions, no study, to the best of our knowledge, has evaluated whether the outcomes of patients with these various melanoma subtypes differ after the diagnosis of metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Mucosal, Uveal, Acral, Nonacral Cutaneous, and Unknown Primary Melanoma From the Time of First Metastasis

et al. 2016

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Background. Subtypes of melanoma, such as mucosal, uveal, and acral, are believed to result in worse prognoses than nonacral cutaneous melanoma. After a diagnosis of distant metastatic disease, however, the overall survival of patients with mucosal, uveal, acral, nonacral cutaneous, and unknown primary melanoma has not been directly compared. Materials and Methods. We conducted a single-center, retrospective analysis of 3,454 patients with melanoma diagnosed with distant metastases from 2000 to 2013, identified from a prospectively maintained database. We examined melanoma subtype, date of diagnosis of distant metastases, age at diagnosis of metastasis, gender, and site of melanoma metastases. Results. Of the 3,454 patients (237 with mucosal, 286 with uveal, 2,292 with nonacral cutaneous, 105 with acral cutaneous, and 534 with unknown primary melanoma), 2,594 died. The median follow-up was 46.1 months. The median overall survival for those with mucosal, uveal, acral,

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“…Therefore, the correct diagnosis is often delayed, leading to a poor prognosis of malignant tumors, especially mucosal melanomas [6]. Possible differential diagnoses of our case include herpes infection, condylomata acuminata, condyloma lata of syphilis, inflamed cysts or glands, and squamous cell carcinoma.…”

Section: Resultsmentioning

confidence: 99%

Dermoscopic appearance of an amelanotic mucosal melanoma

Blum

Beck-Zoul

Held

et al. 2016

Dermatol Pract Concept

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BackgroundHypomelanotic or amelanotic melanomas are challenging to identify, especially at mucosal sites. The dermoscopic clues to the diagnosis of mucosal melanomas have been reported to be structureless zones with the presence of blue, gray, or white colors.CaseA female in her seventies noted a new lesion on the inside of her right labia that first appeared two months prior. Her past medical history was significant for rheumatoid arthritis requiring ongoing treatment with methotrexate for 20 years and adalimumab for 10 years. After no response to two weeks of local treatment for suspected herpes simplex infection, her gynecologist performed a skin biopsy. Based on the histopathological diagnosis of an amelanotic melanoma (Breslow thickness of 1.3 mm) the patient was referred to dermatology for further assessment. Polarized dermoscopy revealed a distinct asymmetric, sharply demarcated homogenous white papule (4 × 5 mm) as well as polymorphous vessels.ConclusionDermoscopy may aid in the diagnosis of amelanotic mucosal melanomas. Our case revealed a structureless white area and polymorphous vessels. Additional clues to the diagnosis were the advanced age of the patient and the clinical presentation of a new lesion.

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Primary Localization and Tumor Thickness as Prognostic Factors of Survival in Patients with Mucosal Melanoma

Cited by 23 publications

References 13 publications

Clinics, prognosis and new therapeutic options in patients with mucosal melanoma

Clinics, prognosis and new therapeutic options in patients with mucosal melanoma

Prognosis of Mucosal, Uveal, Acral, Nonacral Cutaneous, and Unknown Primary Melanoma From the Time of First Metastasis

Dermoscopic appearance of an amelanotic mucosal melanoma

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