Cutaneous melanoma: In transit metastases
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Douglas Tyler, MD
Douglas Tyler, MD
- Department of Surgery
- University of Texas Medical Branch at Galveston
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
For patients with primary cutaneous melanoma, the term "locoregional metastases" includes local recurrences, in transit and satellite metastases, and regional lymph node metastases.
The clinical presentation, evaluation, and management of patients with in transit metastases will be reviewed here. Local recurrences and nodal metastases are discussed separately. (See "Cutaneous melanoma: Management of local recurrence" and "Evaluation and treatment of regional lymph nodes in melanoma".)
In transit metastases are located within regional dermal and subdermal lymphatics prior to reaching the regional lymph nodes. The American Joint Committee on Cancer (AJCC) defines in transit metastases as any skin or subcutaneous metastases that are more than 2 cm from the primary lesion but are not beyond the regional nodal basin . Lesions occurring within 2 cm of the primary tumor are classified as satellite metastases. The 2010 tumor, node, metastasis (TNM) staging system (table 1A-B) considers in transit and satellite metastases to be a component of nodal (N) staging, assigning a separate N2c designation when they arise in the absence of nodal metastases. In the eighth (2017) AJCC TNM staging system, non-nodal regional disease is stratified by category according to the number of tumor-involved lymph nodes (table 2A and table 2B). (See "Tumor node metastasis (TNM) staging system and other prognostic factors in cutaneous melanoma".)
In transit metastases are differentiated from satellite lesions, which are skin or subcutaneous lesions within 2 cm of the primary tumor that are considered intralymphatic extensions of the primary mass. Despite this distinction, the tumor biology associated with satellite and in transit metastases is similar, and they are not considered as distinct entities for treatment or prognosis [2,3].
Melanoma in transit metastases typically appear as erythematous nodules ranging in size from 0.2 to 2 cm that may or may not be pigmented. Occasionally, the lesions are flat rather than nodular.
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- CLINICAL PRESENTATION
- INCIDENCE AND INFLUENCE OF NODE DISSECTION
- General approach
- - Positive resection margins
- Regional chemotherapy
- - Isolated limb perfusion
- - Isolated limb infusion
- - Outcomes
- ILI or ILP after resection of in transit recurrence
- High-risk primary melanoma
- - Progression after regional chemotherapy treatment
- Radiation therapy
- Intralesional therapy
- Adjuvant systemic therapy
- Systemic therapy
- SUMMARY AND RECOMMENDATIONS