Lymphatic versus Hematogenous Melanoma Metastases: Support for Biological Heterogeneity without Clear Clinical Application.

Melanoma demonstrates considerable biological heterogeneity and is associated with several routes of dissemination including lymphatic and hematogenous. Locoregional control via surgery may improve outcomes for patients with limited lymphatic metastases. Once stage IV disease is diagnosed, clinical outcomes are determined by molecular and/or immunologic factors and identification of tumor/microenvironmental features correlating with distant metastases is critical for future prognostic stratification.