Cervical Lymph Node Metastasis from Melanoma of an Unknown Primary Site - Case Report

Abstract

Cancer can occasionally manifest initially as nodal metastases without any known primary site. Metastatic melanoma with an unknown primary site is a relatively unusual clinical entity with a reported incidence of between 1 and 15%. Regional lymph node metastasis accounts for up to 64% of metastatic melanoma. We report a 71-year-old woman who presented with metastatic melanoma of the retroauricular, middle jugular and posterior triangle lymph nodes with an unknown primary site. Radical neck dissection was performed. A retrospective search for a primary melanoma disclosed a pigmented lesion over her scalp. However, pathology of the resected lesion was negative for malignancy. The patient remained well without recurrent disease after 3 years of follow-up. Diagnosis of metastatic melanoma of the cervical lymph nodes with an unknown primary site should only be made after a careful search for primary melanoma in the cutaneous and mucosal surfaces of the head and neck. Neck dissection is the treatment of choice, and survival is not significantly different from patients with known primary sites.