{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,13]],"date-time":"2025-04-13T09:10:03Z","timestamp":1744535403426,"version":"3.40.4"},"reference-count":11,"publisher":"Scientific Foundation Spiroski (publications)","issue":"7","license":[{"start":{"date-parts":[[2017,12,4]],"date-time":"2017-12-04T00:00:00Z","timestamp":1512345600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Open Access Maced J Med Sci"],"abstract":"<jats:p>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\u00e2\u20ac\u2122 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 \u00e2\u20ac\u201c 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.<\/jats:p>","DOI":"10.3889\/oamjms.2017.222","type":"journal-article","created":{"date-parts":[[2017,12,9]],"date-time":"2017-12-09T09:14:29Z","timestamp":1512810869000},"page":"970-973","source":"Crossref","is-referenced-by-count":4,"title":["Primary Solitary Melanoma of the Lymphatic Nodes Or a Single Metastasis of Unknown Melanoma: Do We Need a New Staging System?"],"prefix":"10.3889","volume":"5","author":[{"given":"Georgi","family":"Tchernev","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasiya","family":"Chokoeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyubomira Victor","family":"Popova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"52292","published-online":{"date-parts":[[2017,12,4]]},"reference":[{"key":"37694","unstructured":"Heppt MV, Tietze JK, Reinholz M, Rahimi F, Jung A, Kirchner T, Ruzicka T, Flaig MJ, Berking C. Disease kinetics but not disease burden is relevant for survival in melanoma of unknown primary tumour. Discov Med. 2015; 20(110):231-7. PMid:26562476"},{"key":"37695","doi-asserted-by":"crossref","unstructured":"Katz KA, Jonasch E, Hodi FS, Soiffer R, Kiwitkiwiski K, Sober AJ, Haluska FG. Melanoma of unknown primary: the experience of Massachusetts General Hospital and Dana- Farber Cancer Institute. Melanoma Res. 2005; 15(1):77-82. https:\/\/doi.org\/10.1097\/00008390-200502000-00013 PMid:15714125","DOI":"10.1097\/00008390-200502000-00013"},{"key":"37696","doi-asserted-by":"crossref","unstructured":"Kamposioras K, Pentheroudakis G, Pavlidis D. Malignant Melanoma of unknown primary site. To make the long story short. A systematic reviw of the literature. 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Cancer. 1977; 39:164\u00e2\u20ac\u201c171. https:\/\/doi.org\/10.1002\/1097-0142(197701)39:1<164::AID-CNCR2820390127>3.0.CO;2-T","DOI":"10.1002\/1097-0142(197701)39:1<164::AID-CNCR2820390127>3.0.CO;2-T"},{"key":"37699","doi-asserted-by":"crossref","unstructured":"Samadder NJ, Smith KR, Hanson H, Pimentel R, Wong J, Boucher K, Akerley W, Gilcrease G, Ulrich CM, Burt RW, Curtin K. Familial Risk in Patients With Carcinoma of Unknown Primary. JAMA Oncol. 2016; 2(3):340-6. https:\/\/doi.org\/10.1001\/jamaoncol.2015.4265 PMid:26863281","DOI":"10.1001\/jamaoncol.2015.4265"},{"key":"37700","doi-asserted-by":"crossref","unstructured":"Giuliano AE, Mosely SH, Morton DL. Clinical aspects of Unknown Primary Melanoma. Ann Surg. 1980; 191(1):98-104. https:\/\/doi.org\/10.1097\/00000658-198001000-00018 PMid:7352784 PMCid:PMC1344625","DOI":"10.1097\/00000658-198001000-00018"},{"key":"37701","doi-asserted-by":"crossref","unstructured":"Christopoulos P, Doulias T, Koutelidakis I, Papaziogas B. Stage four malignant melanoma of unknown primary site in young man. BMJ Case report. 2012. https:\/\/doi.org\/10.1136\/bcr-2012-006283","DOI":"10.1136\/bcr-2012-006283"},{"key":"37702","doi-asserted-by":"crossref","unstructured":"Toba H, Kondo K, Otsuka H, Takizawa H, Kenzaki K, Sakiyama S, Tangoku A. Diagnosis of the presence of lymph node metastasis and decision of operative indication using fluorodeoxyglucose-positron emission tomography and computed tomography in patients with primary lung cancer. J Med Invest. 2010; 57(3-4):305-13. https:\/\/doi.org\/10.2152\/jmi.57.305 PMid:20847531","DOI":"10.2152\/jmi.57.305"},{"key":"37703","doi-asserted-by":"crossref","unstructured":"Yu X, Li X, Song X, Dai D, Zhu L, Zhu Y, Wang J, Zhao H, Xu W. Advantages and disadvantages of F-18 fluorodeoxyglucose positron emission tomography\/computed tomography in carcinoma of unknown primary. 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