Conventional and three-dimensional photography as a tool to map distribution patterns of in-transit melanoma metastases on the lower extremity

Kilian Müller; Carola Berking; Caroline Voskens; Markus V Heppt; Lucie Heinzerling; Elias A T Koch; Rafaela Kramer; Susanne Merkel; Beatrice Schuler-Thurner; Vera Schellerer; Theresa Steeb; Anja Wessely; Michael Erdmann

doi:10.3389/fmed.2023.1089013

Conventional and three-dimensional photography as a tool to map distribution patterns of in-transit melanoma metastases on the lower extremity

Front Med (Lausanne). 2023 Jan 19:10:1089013. doi: 10.3389/fmed.2023.1089013. eCollection 2023.

Authors

Kilian Müller¹, Carola Berking^{2

3}, Caroline Voskens^{2

3}, Markus V Heppt^{2

3}, Lucie Heinzerling⁴, Elias A T Koch^{2

3}, Rafaela Kramer^{2

3}, Susanne Merkel^{3

5}, Beatrice Schuler-Thurner^{2

3}, Vera Schellerer⁶, Theresa Steeb^{2

3}, Anja Wessely^{2

3}, Michael Erdmann^{2

3}

Affiliations

¹ Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany.
² Department of Dermatology, Uniklinikum Erlangen, Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
³ Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany.
⁴ Department of Dermatology and Allergy, University Hospital Munich, Ludwig Maximilian University of Munich, Munich, Germany.
⁵ Department of Surgery, Uniklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
⁶ Department of Pediatric Surgery, University Medicine Greifswald, Greifswald, Germany.

Abstract

Background: In melanoma, in-transit metastases characteristically occur at the lower extremity along lymphatic vessels.

Objectives: The objective of this study was to evaluate conventional or three-dimensional photography as a tool to analyze in-transit metastasis pattern of melanoma of the lower extremity. In addition, we assessed risk factors for the development of in-transit metastases in cutaneous melanoma.

Methods: In this retrospective, monocentric study first we compared the clinical data of all evaluable patients with in-transit metastases of melanoma on the lower extremity (n = 94) with melanoma patients without recurrence of disease (n = 288). In addition, based on conventional (n = 24) and three-dimensional photography (n = 22), we defined the specific distribution patterns of the in-transit metastases on the lower extremity.

Results: Using a multivariate analysis we identified nodular melanoma, tumor thickness, and ulceration as independent risk factors to develop in-transit metastases ITM (n = 94). In patients with melanoma on the lower leg (n = 31), in-transit metastases preferentially developed along anatomically predefined lymphatic pathways. In contrast when analyzing in-transit metastases of melanoma on the foot (n = 15) no clear pattern could be visualized. In addition, no difference in distance between in-transit metastases and primary melanoma on the foot compared to the lower leg was observed using three-dimensional photography (n = 22).

Conclusion: A risk-adapted follow-up of melanoma patients to detect in-transit metastases can be applied by knowledge of the specific lymphatic drainage of the lower extremity. Our current analysis suggests a more complex lymphatic drainage of the foot.

Keywords: 3D photography; in-transit metastasis; lower extremity; lymphatic pathways; melanoma.