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The Prognosis and Natural History of In-Transit Melanoma Metastases at a High-Volume Centre

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with in-transit melanoma metastases (ITM) experience a diverse spectrum of clinical presentations and a highly variable disease course. There is no standardized treatment protocol for these patients due to the limited data comparing treatment modalities for ITM. This is the first study to describe the disease trajectory and natural history of a large cohort of patients with ITM.

Methods

A retrospective study of patients treated for ITM between 2004 and 2018 at the Peter MacCallum Cancer Centre was performed. Clinical and pathological characteristics for primary and in-transit episodes were analyzed for predictors of relapse-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival.

Results

A total of 109 patients with 303 episodes of ITM were identified: 52 (48%) females, median age 70.1 years (range 35–92). The median RFS for all episodes was 5 months (95% confidence interval [CI] 4.2–5.7). Eighty-seven percent of episodes involving isolated in-transit lesions underwent surgical excision, compared with 17% involving more than five in-transit lesions. A trend was seen between a greater number of lesions and shorter RFS (p = 0.055). The median DMFS was 34.8 months (95% CI 22.8–51.6). Factors associated with shorter DMFS included primary tumor thickness (hazard ratio [HR] 1.08, 95% CI 1.01–1.15; p = 0.026), site of primary tumor (p = 0.008), and BRAF mutation (HR 2.12, 95% CI 1.14–3.94; p = 0.018).

Conclusions

Locoregional relapse is common in patients with ITM regardless of treatment modality. Characteristics of the ITM may predict for RFS, while primary tumor characteristics remain important predictors of DMFS.

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Acknowledgment

Melanoma Research Victoria.

Funding

No sources of funding were used in the preparation of this study.

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Authors and Affiliations

  1. Division of Cancer Surgery, Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Emilia Nan Tie MD, John Spillane MBBS, FRACS, David Speakman MBBS, FRACS, Michael A. Henderson MBBS, MD, FRACS & David E. Gyorki MBBS, MD, FRACS

  2. Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia

    Emilia Nan Tie MD, John Spillane MBBS, FRACS, Michael A. Henderson MBBS, MD, FRACS & David E. Gyorki MBBS, MD, FRACS

  3. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Lumine H. Na MS

  4. Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    Rodney J. Hicks MD, FRACP, FAHMS

  5. Department of Medicine/Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia

    Rodney J. Hicks MD, FRACP, FAHMS

  6. Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia

    David E. Gyorki MBBS, MD, FRACS

Authors
  1. Emilia Nan Tie MD
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  2. Lumine H. Na MS
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  3. Rodney J. Hicks MD, FRACP, FAHMS
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Corresponding author

Correspondence to David E. Gyorki MBBS, MD, FRACS.

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Disclosure

Emilia Nan Tie, Lumine H. Na, Rodney J. Hicks, John Spillane, David Speakman, Michael A. Henderson, and David E. Gyorki have no conflicts of interest to declare.

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Nan Tie, E., Na, L.H., Hicks, R.J. et al. The Prognosis and Natural History of In-Transit Melanoma Metastases at a High-Volume Centre. Ann Surg Oncol 26, 4673–4680 (2019). https://doi.org/10.1245/s10434-019-07965-w

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  • DOI: https://doi.org/10.1245/s10434-019-07965-w

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