Primary Solitary Melanoma of the Lymphatic Nodes Or a Single Metastasis of Unknown Melanoma: Do We Need a New Staging System?

BACKGROUND: Malignant melanoma is a disease which has a cutaneous origin in 90% of the patients, but in rare cases, it could be discovered as secondary deposits with unknown primary site. Metastatic Malignant Melanoma occurs without a primary site in about 3% of all melanoma patients, and it could be divided into two main groups: metastatic lymph nodes' involvement or non-lymph nodes disease. The lack of unified classification and staging system, provided by AJCC (2009), as well as the lack for curtain diagnostic and therapeutic protocol, prompt us to raise the question what is the right way to precede in cases of metastasis of the lymph nodes, without evidence of a primary tumour?

CASE REPORT: We report a case of 67-years- old woman who presented in the dermatology clinic after a surgical removal of an enlarged lymph node in her left femoral area, verified histologically as a metastasis of melanoma. After a diagnostic refinement in the clinic, the diagnosis of metastasis of malignant melanoma was confirmed by histology revision. We use the presented case to create for the first time in the world literature a novel stereotype of thinking, which is also followed by a stereotype of clinical behaviour - gentle to the patient, but providing a certain amount of security and satisfaction for the medical staff.

CONCLUSION: The affection of a single lymph node in the absence of a primary tumour should not automatically lead to the conclusion that it is a single metastasis, but rather a primary melanoma of the lymph nodes, in cases of a negative PET scan, for example. In these cases, the measuring of the tumour thickness should guide the further therapeutic behaviour and determine the approach.