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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank the author for his interest in our article and find his observations very interesting and enlightening&#46; However&#44; we believe it necessary to make some clarifications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Even before the publication of the 2009 American Joint Committee on Cancer &#40;AJCC&#41; Staging and Classification&#44; various authors had studied melanoma metastasis from an unknown primary site and concluded that survival in such cases was higher than in known primary cutaneous melanomas and metastases with a similar clinical presentation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This improved survival has been reported for metastases in the skin and subcutaneous tissue and for local lymph node disease with an unknown primary site&#46; The survival rates are similar to those expected for regional disease &#40;stage III&#41; and nonmetastatic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the latest AJCC classification&#44; single skin or subcutaneous metastases are considered to be satellite or in-transit metastases&#44; while metastases in the lymph nodes are considered to be regional&#46; In both cases they are categorized as stage III and are therefore associated with higher survival rates&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This classification&#44; however&#44; is based only on the observation of better survival in such cases and no consideration is given to the origin of these cutaneous or subcutaneous lesions classified as satellite or in-transit &#40;and therefore metastatic&#41; lesions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We are interested in the fact that these lesions might also have a primary origin&#44; as this would have new implications for the management of patients beyond a mere classification determining survival and prognosis&#46; As reported by Lee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> 23&#37; of patients with solitary dermal melanoma &#40;SDM&#41; may have nodal disease at the time of diagnosis or later and would therefore benefit from sentinel node biopsy and&#44; if indicated&#44; lymphadenectomy&#46; It is noteworthy that sentinel node biopsy would not be indicated if the disease was already considered to be metastatic&#44; although lymphadenectomy might be an option if there is nodal involvement following on from an in-transit metastasis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Given the different potential origins of a single focus of melanoma in the dermis or subcutaneous tissue&#44; we agree that a diagnosis of primary dermal melanoma is just one option when faced with SDM&#46;</p></span>"
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Letter to the Editor
Response to “Stage IIIC Solitary Dermal Melanoma”
Réplica a «Melanoma dérmico solitario y estadio IIIC»
M. González de Arriba
Servicio de Dermatología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We thank the author for his interest in our article and find his observations very interesting and enlightening&#46; However&#44; we believe it necessary to make some clarifications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Even before the publication of the 2009 American Joint Committee on Cancer &#40;AJCC&#41; Staging and Classification&#44; various authors had studied melanoma metastasis from an unknown primary site and concluded that survival in such cases was higher than in known primary cutaneous melanomas and metastases with a similar clinical presentation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This improved survival has been reported for metastases in the skin and subcutaneous tissue and for local lymph node disease with an unknown primary site&#46; The survival rates are similar to those expected for regional disease &#40;stage III&#41; and nonmetastatic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the latest AJCC classification&#44; single skin or subcutaneous metastases are considered to be satellite or in-transit metastases&#44; while metastases in the lymph nodes are considered to be regional&#46; In both cases they are categorized as stage III and are therefore associated with higher survival rates&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This classification&#44; however&#44; is based only on the observation of better survival in such cases and no consideration is given to the origin of these cutaneous or subcutaneous lesions classified as satellite or in-transit &#40;and therefore metastatic&#41; lesions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We are interested in the fact that these lesions might also have a primary origin&#44; as this would have new implications for the management of patients beyond a mere classification determining survival and prognosis&#46; As reported by Lee et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> 23&#37; of patients with solitary dermal melanoma &#40;SDM&#41; may have nodal disease at the time of diagnosis or later and would therefore benefit from sentinel node biopsy and&#44; if indicated&#44; lymphadenectomy&#46; It is noteworthy that sentinel node biopsy would not be indicated if the disease was already considered to be metastatic&#44; although lymphadenectomy might be an option if there is nodal involvement following on from an in-transit metastasis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Given the different potential origins of a single focus of melanoma in the dermis or subcutaneous tissue&#44; we agree that a diagnosis of primary dermal melanoma is just one option when faced with SDM&#46;</p></span>"
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ISSN: 15782190
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