Unknown Primary Melanoma: Worldwide Survey on Clinical Management

Abstract

Background: How to deal with melanoma of unknown primary (MUP) origin is a debated topic in the literature. Objective: We performed a worldwide survey to inquire what clinical and investigational workup is performed as well as the physicians' perception of this disease. Methods: A questionnaire was sent via mail to clinicians involved in melanoma care from December 2015 to April 2016 using the International Dermoscopy Society website. Results: 119 physicians from 47 different countries answered the questionnaire. The most reported examination was skin examination followed by CT and/or PET scans. All the participants declared asking about previous excisions of skin lesions with 81% of them asking for a histopathological slide review of previous biopsies. Half of the participants checked for a possible vitiligo phenomenon that may explain regression of the primary lesion. BRAF, cKIT, and GNAQ mutations were screened by 32% of participants. The majority of participants (76%) applied the same treatment protocols for MUP as patients with known primary melanomas of the same AJCC stage. Conclusion: Strong heterogeneity was found between physicians dealing with MUP. Thus, a consensus document should be strongly encouraged.

Treatment of melanoma of unknown primary in the era of immunotherapy and targeted therapy: A Dutch population‐based study

“…19 Although there are no specific treatment recommendations for patients with MUP, physicians tend to apply similar strategies for patients with stage-matched MKP. 20 This approach is supported by the results of a large study into the molecular characterisation of patients diagnosed with MUP, in which it was shown that the clinical behaviours and molecular patterns of BRAF/NRAS alterations were similar between patients with MUP and stage-matched MKP. 21 The percentage of Dutch patients diagnosed with stage IV MUP who were primarily treated with novel therapy increased considerably during the study period.…”

“…In clinical trials, these immunotherapy and targeted therapy approaches have reported median OS durations that exceed 30 months and 20 months, respectively . Although there are no specific treatment recommendations for patients with MUP, physicians tend to apply similar strategies for patients with stage‐matched MKP . This approach is supported by the results of a large study into the molecular characterisation of patients diagnosed with MUP, in which it was shown that the clinical behaviours and molecular patterns of BRAF/NRAS alterations were similar between patients with MUP and stage‐matched MKP …”

Arrhythmias in a patient with metastatic melanoma treated with targeted therapy and implantable cardioverter defibrillator

“…The brain lesion was excised and the histological examination confirmed that the melanoma showed the BRAF V600E mutation. We did not detect skin lesions that could be referred to a primary melanoma . No histological data were available from a pigmented lesion on the left big toe, removed when he was 36 years old.…”

“…We did not detect skin lesions that could be referred to a primary melanoma. 7 No histological data were available from a pigmented lesion on the left big toe, removed when he was 36 years old.…”

Patients with melanoma of unknown primary show better outcome under immune checkpoint inhibitor therapy than patients with known primary: preliminary results

“…1,2 Once melanoma has spread into the lymph nodes, or even visceral organs and the brain, it remains a life-threatening disease despite the advent of molecular targeted or immunotherapies. 1,2 Melanoma of unknown primary (MUP) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] represents an unusual subtype of melanoma which was reported to be about 2-9% of melanoma of known primary (MKP) at all stages. 3 Some of the literature in the different geographic regions demonstrated better overall survival of MUP than of MKP.…”