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Comparison of Survival for Patients With Metastases From Known vs Unknown Primary Tumor Sites

Beverly Y. Wang, MD; William Lawson, MD, DDS; Robert A. Robinson, MD, PhD; Bayardo Perez-Ordonez, MD; Margaret Brandwein, MD

Arch Otolaryngol Head Neck Surg. 1999;125:635-639.

Background  Malignant melanoma (MM) rarely affects the parotid, and usually this diagnosis will herald a search for a primary skin neoplasm. Occasionally, no primary tumor is ever found, raising questions regarding prognosis and the issue of primary melanoma of the parotid.

Objective  To evaluate retrospectively the clinical and histological features of MM involving the parotid in 19 patients.

Data Sources  Pathology and hospital files at 3 tertiary care university hospitals.

Study Selection  Patients with MM within the parotid with adequate histopathologic and immunohistochemical documentation, as well as clinical information regarding patient outcome.

Data Extraction  In 6 patients, no extraparotid MM was ever identified. After parotidectomy, 5 patients (including 1 patient who died of other causes) were melanoma free at a mean of 4.2 years (range, 14 months to 7.5 years). Only 1 patient died of disease after 17 months. An extraparotid primary tumor was present in 13 patients, 10 with dermal and 3 with mucosal sites. At follow-up, only 1 of these patients was disease free after 2 years. Nine patients died of melanoma after a mean of 2.6 years (range, 10 months to 5 years); the other 3 had evidence of metastatic disease at a mean of 4.3 years (range, 3-6 years). Nondermal sites of primary tumors were the nasal cavity, sclera, and conjunctiva.

Data Synthesis  Patients with metastatic MM from unknown primary tumors have a longer disease-free survival than those with metastases from known primary disease.

Conclusions  Although rare, MM should be considered in the differential diagnosis of parotid tumors. Unusual mucosal or ocular sites should be considered in the search for possible primary tumor sites to avoid treatment delay. These data support the idea that patients with metastatic MM from unknown primary tumors may follow a more improved course than that of patients with metastases from known primary disease.

From the Lillian and Henry M. Stratton–Hans Popper Department of Pathology (Drs Wang and Brandwein) and the Department of Otolaryngology–Head and Neck Surgery (Drs Lawson and Brandwein), Mount Sinai Medical Center, New York, NY; the Department of Pathology, University of Iowa Hospital and Clinics, Iowa City (Dr Robinson); and the Division of Anatomic Pathology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario (Dr Perez-Ordonez).

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