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J Invest Dermatol. 2017 Dec;137(12):2570-2577. doi: 10.1016/j.jid.2017.07.006. Epub 2017 Jul 21.

Serial or Parallel Metastasis of Cutaneous Melanoma? A Study of the German Central Malignant Melanoma Registry.

Author information

1
Center for Dermatooncology, Department of Dermatology, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
2
Center for Dermatooncology, Department of Dermatology, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany; Central Malignant Melanoma Registry, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
3
Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Wuerzburg, Germany.
4
Department of Dermatology and Venereology, Martin-Luther-University of Halle (Saale), Halle (Saale), Germany.
5
Department of Dermatology, University Hospital Erlangen, Erlangen, Germany.
6
Breast Cancer Center, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
7
Institute of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany.
8
Center for Dermatooncology, Department of Dermatology, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany; Central Malignant Melanoma Registry, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany. Electronic address: claus.garbe@med.uni-tuebingen.de.

Abstract

For more than a century the Halstedian hypothesis of contiguous metastasis from the primary tumor through the lymphatics to distant sites shaped lymph node surgery for melanoma. We challenge this dogma of serial metastatic dissemination. A single-center series of 2,299 patients with cutaneous metastatic melanoma was investigated to analyze overall survival and distant metastasis-free survival of stage IV patients with or without primary lymphatic metastasis. Results were then compared with those of 2,134 patients from three independent centers of the German Central Malignant Melanoma Registry. A multivariate binary logistic regression model was used to identify risk factors for the initial metastatic pathway. Distant metastasis-free survival (hazard ratio = 1.02; 95% confidence interval = 0.91-1.14; P = 0.76) and overall survival (HR = 1.09; 95% CI = 0.96-1.23; P = 0.177) did not differ between stage IV patients with primary hematogenous or primary lymphatic metastasis. Melanoma localization was the only significant risk factor for the initial metastatic pathway. These findings indicate that regional and distant metastases originate from the primary tumor itself in a rather parallel than serial fashion and could explain the lack of survival benefit associated with immediate complete lymph node dissection in sentinel lymph node-positive melanoma patients.

PMID:
28736231
DOI:
10.1016/j.jid.2017.07.006
[Indexed for MEDLINE]

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