Annals of Surgical Oncology

, Volume 21, Issue 9, pp 3108–3116 | Cite as

Melanoma Patients with an Unknown Primary Tumor Site Have a Better Outcome than Those with a Known Primary Following Therapeutic Lymph Node Dissection for Macroscopic (Clinically Palpable) Nodal Disease

  • Augustinus P. T. van der Ploeg
  • Lauren E. Haydu
  • Andrew J. Spillane
  • Richard A. Scolyer
  • Michael J. Quinn
  • Robyn P. M. Saw
  • Kerwin F. Shannon
  • Jonathan R. Stretch
  • John F. ThompsonEmail author



Several reports in the literature suggest a difference in outcome between melanoma patients with macroscopic (clinically palpable) nodal disease from an unknown primary (MUP) and a known primary (MKP). The purpose of this study was to compare the outcomes for MUP and MKP patients after therapeutic lymph node dissection (TLND) for macroscopic nodal disease.


From a large, prospective, single-institution database, the details of melanoma patients who first presented with macroscopic nodal disease and underwent TLND between 1971 and 2010 were extracted and analyzed.


There were 287 MUP patients and 264 MKP patients who fulfilled the study selection criteria. MUP patients had better disease-free, distant metastasis-free, and melanoma-specific survival after their TLND than MKP patients (all p < 0.001). Extranodal melanoma extension, >3 positive lymph nodes, and administration of adjuvant radiotherapy were all independent predictors of reduced disease-free and melanoma-specific survival (all p < 0.05). MUP patients also had a better prognosis than MKP patients whose primary melanoma had regression (p = 0.001).


The occurrence and improved outcome of MUP patients may be due to immune-induced total regression of the primary tumor and better immunologic prevention or control of distant metastatic disease. Alternatively, in some MUP patients, melanoma may not be metastatic but may originate de novo from nevus cells in lymph nodes, with the more favorable prognosis attributable to their primary nodal origin and complete surgical resection.


Melanoma Adjuvant Radiotherapy Melanoma Patient Primary Melanoma Nevus Cell 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of Interest

A. P. T. van der Ploeg was supported by the European Organization for Research and Treatment of Cancer during a Research Fellowship at Melanoma Institute Australia. R. A. Scolyer is a Cancer Institute New South Wales Research Fellow. For the remaining authors, none was declared.

Supplementary material

10434_2014_3679_MOESM1_ESM.tif (960 kb)
Supplementary Fig. 1 Disease-free survival (TIFF 959 kb)
10434_2014_3679_MOESM2_ESM.tif (960 kb)
Supplementary Fig. 2 Disease metastasis–free survival (TIFF 959 kb)
10434_2014_3679_MOESM3_ESM.tif (960 kb)
Supplementary Fig. 3 Melanoma-specific survival for unknown primary versus known primary with regression versus known primary without regression (TIFF 959 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Augustinus P. T. van der Ploeg
    • 1
  • Lauren E. Haydu
    • 1
    • 2
  • Andrew J. Spillane
    • 1
    • 2
  • Richard A. Scolyer
    • 1
    • 2
  • Michael J. Quinn
    • 1
    • 2
  • Robyn P. M. Saw
    • 1
    • 2
  • Kerwin F. Shannon
    • 1
    • 2
  • Jonathan R. Stretch
    • 1
    • 2
  • John F. Thompson
    • 1
    • 2
    Email author
  1. 1.Melanoma Institute AustraliaSydneyAustralia
  2. 2.Sydney Medical SchoolThe University of SydneySydneyAustralia

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