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Melanoma has the distinction of being particularly dangerous because of its propensity to metastasize. Standard models of metastatic dissemination often posit an orderly progression sequence that involves seeding of regional metastases prior to development of distant metastases. This model makes sense, is borne out by most clinical experience, is relevant to anatomic-based staging, and provides the rationale for the benefit of sentinel lymph node biopsy.
To further examine how melanoma metastasizes, Sanborn and colleagues used a clever application of deep sequencing to samples of primary melanomas from eight patients and matched lymph node, skin, and distant metastases. By examining the proportions of mutations present in tumors and looking …