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Query: UMLS:C0025202 (melanoma)
 69,561 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There are several recognizable melanocytic precursors of cutaneous melanoma. These precursors include lentigo maligna, dysplastic melanocytic nevi, congenital nevi (of any size), and darkly pigmented lesions of acral surfaces and mucous membranes. Lentigo maligna is an uncommon melanocytic dysplasia, present in 3 per 1000 individuals over the age of 50 years and accounting for 4 percent of all cutaneous melanomas. Dysplastic melanocytic nevi are present in 2 per cent of white adults, and may account for at least a fifth of cases of cutaneous melanoma. Congenital nevomelanocytic nevi are present in 1 per cent of newborns; the vast majority of congenital nevi are smaller than 3 to 4 cm in diameter, while very large congenital nevi are present in 1 in 20,000 to 1 in 500,000 newborns. Very large congenital nevi account for less than 0.1 percent of cutaneous melanomas, whereas small varieties of congenital nevi may account for 15 percent of cutaneous melanomas. If individuals with lentigo maligna live long enough, possibly a third to a half are said to develop melanoma. This figure may be biased high. Persons with dysplastic melanocytic nevi in the familial melanoma setting have an estimated lifetime risk of developing melanoma approaching 100 per cent. Persons with dysplastic melanocytic nevi in other settings may have a lifetime melanoma risk of 18 per cent. Persons with congenital nevi of any size may have a lifetime melanoma risk of at least 5 per cent. Early recognition of these precursor melanocytic tumors, particularly in high-risk individuals (i.e., those with a personal or family history of melanoma), and careful photographic follow-up or prophylactic excision of these lesions may be the most effective means of reducing the morbidity and mortality of cutaneous melanoma. The impact of routine screening and excision of presumed melanoma precursors is unknown. Clinical judgment is required to balance the theoretical risk of melanoma associated with a given precursor and the known risks of surgery and anesthesia for a given individual. It must be kept in mind that the vast majority of acquired melanocytic nevi in adults are harmless. Probably even the majority of dysplastic nevi and small congenital nevi will remain unchanged throughout life. The simple recognition of the existence of melanoma precursors will heighten suspicion for these lesions and raise awareness of the earliest signs of malignant change.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Melanocytic precursors of cutaneous melanoma. Estimated risks and guidelines for management. 351 Mar 47

Dermatologists are often faced with the decision of when to operate on a child at risk for developing malignant melanoma in a large congenital nevocytic nevus. As a series of operations is usually required, an understanding of the lethal and nonlethal effects of the general anesthesia is necessary. This paper discusses these potential iatrogenic effects on the child's physical and psychological development. Suggestions are given for optimal times to operate, considering both psychological and physical factors, (i.e., 6-9 months or 8-12 years of age) and ways to minimize unwanted side effects.
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PMID:Iatrogenic effects of general anesthesia in children: considerations in treating large congenital nevocytic nevi. 351 16

Similar to other countries, the incidence of malignant melanoma (MM) is significantly increasing in the Federal Republic of Germany. In established MM, curative therapeutic measures are limited. Current worldwide effort is therefore being directed toward its early recognition and the immediate surgical removement of the primary tumor, with a safety margin of at least 3 cm from the edge of the tumor in all cases. General anesthesia seems preferable and is used in most German university departments of dermatology. Another essential requirement is to subdivide clinical stage I into several risk groups since the 5-year survival rate of each individual case included in this stage may vary from greater than 90% to less than 50%; this can be accomplished by analyzing two main prognostic criteria that will largely determine the final outcome: tumor thickness, and tumor localization. Sex may also play a role in some cases. Other prognostic factors should also be considered. The selection of postoperative therapeutic measures (including prophylactic immunotherapy, prophylactic chemotherapy, and prophylactic regional lymphadenectomy) will then depend on the prognostic risk expected for each patient. This approach means that all of the main individual parameters must be carefully evaluated, and this is time-consuming, but it seems to be more appropriate than any other method for achieving optimal therapeutic results. When MM are in the late metastasizing clinical stages only palliative measures are currently possible, and there is little hope, if any, for a final cure.
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PMID:[Prognosis-oriented therapy of malignant melanoma. New concepts]. 374 22

The pharmacokinetics of isolated limb perfusion were studied to see what melphalan concentrations were achieved and how effective the isolation was. Twenty-eight patients received 32 limb perfusions with heat and melphalan for locally recurrent or level V melanoma. Melphalan was given 0.75 mg/kg for axillary/popliteal or 1.2 mg/kg for femoral perfusions with heat (perfusate 42 degrees C, limb 40 degrees C) for 1 hour. Melphalan concentratives were measured by high-performance liquid chromatography in seven patients. Peak perfusate melphalan concentrations were 6.1 to 115 mg/ml, which was one to two logs higher than peak systemic concentratives of melphalan. Isolation of the perfusate circuit from the systemic circulation was better for axillary and popliteal perfusions than for femoral perfusions (P less than 0.05). Complete responses were seen in 81% of evaluable patients; long-term local control was achieved in most patients, although many developed hematogenous metastases. Toxicity included erythema and edema in all, mild leukopenia in two, neuropathy in two, and amputation was required in one patient. Improvements in surgical technique include regional anesthesia to reduce vasospasms and transcutaneous measurement of fluorescein to measure leak. Perfusion with heat and melphalan remains the treatment of choice for in-transit metastases from melanoma.
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PMID:A clinical and pharmacokinetic study of isolated limb perfusion with heat and melphalan for melanoma. 399 75

A 51-year-old female patient died of Budd-Chiari syndrome during treatment with adjuvant DTIC mono-chemotherapy for malignant melanoma. We report on clinical course and laboratory findings in detail. Differentiating BCS from VOD, we describe the liver damages referring to the latest findings about the effect of DTIC in fibrinolysis. In order to prevent further lethal complications, we suggest to regard pre-existing liver damage as a contra-indication for DTIC therapy; to prefer intraspinal anesthesia for malignant melanoma of the lower extremities; to avoid hepatotoxic drugs and alcohol during chemotherapy; to protect DTIC from light; to extend the interval between first and second cycle. Laboratory data, the "finger-prints" of DTIC, are unreliable. Great attention should be paid to clinical findings which may justify immediate and high dose corticosteroid therapy as well as intensive care monitoring.
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PMID:[Budd-Chiari syndrome following dacarbazine therapy of malignant melanoma--an avoidable complication?]. 402 78

Transfer of tumor immunity as adjuvant cancer therapy has been a topic of intense interest. We have examined the efficacy of various combinations of surgery, xenogeneic immune RNA, xenogeneic normal RNA, tumor vaccine, and nonspecific splenocytes as adjuvant therapy for B16 melanoma in the C57BL/6J mouse system. B16 melanoma was transplanted by trocar into the right hind limb of 6-week-old mice. The tumors were readily palpable on the ninth day posttransplantation. The tumors were amputated at that time under mild anesthesia. Immune RNA was prepared by hot phenol extraction from immune sheep spleens. Various combinations of immune RNA, normal RNA, and tumor antigen, with or without normal mouse spleen cells, were administered every other day for a total of 10 injections. The survival and mode of death was followed up to 120 days. All mice without any treatment died within 30 days. Immunotherapy had no effect on the survival of mice that did not have surgical therapy. Individual group comparisons between mice that underwent surgery only and mice that had surgery plus immune RNA immunotherapy revealed a striking statistical improvement (P less than 0.01). Comparing all groups that received amputation plus various combinations of adjuvant immunotherapy showed no statistical difference in survival. However, immune RNA appears somewhat superior to normal RNA or antigen only. It appears that adjuvant immune RNA immunotherapy following surgical excision in the B16 melanoma model significantly improves survival and retards the spread of metastases.
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PMID:Immune RNA therapy as an effective adjuvant immunotherapy after surgery: an animal model. 618 24

The effect on cell-mediated cytotoxicity of surgery and anesthesia for removal of a primary malignant melanoma was studied in 47 patients. The cytotoxic ability of peripheral blood lymphocytes has been investigated using 2 melanoma cell lines or 2 leukemia cell lines as target cells, with or without addition of interferon or specific antibodies. The cytotoxic ability was clearly reduced in all assays 1 day after the operation. After 6 days about half the patients were totally restored; others showed increase in cytotoxicity without reaching the initial values, whereas one fourth of the patients were still heavily depressed with only a small or no increase at all. The number of macrophages in the effector cell population was followed, and the ability to produce interferon on stimulation with viral or melanoma antigens was investigated, as alterations in these parameters could influence cytotoxicity. There were no fluctuations in these parameters.
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PMID:The influence of general anesthesia and surgery on cell-mediated cytotoxicity and interferon production. 619 85

Seven patients with severe or complete obstruction of the esophagus by malignancy were treated with photoradiation after presensitization of the tumor with intravenous hematoporphyrin derivative. The 625- to 635-nm therapeutic light was delivered from a tunable dye argon laser system coupled through quartz fibers, passed through the biopsy channel of a flexible esophagoscope, with local anesthesia. All tumors (adeno, squamous, and melanoma) responded, and swallowing was improved. Although tumor is still present, one patient is 11 months from initial treatment and is eating a regular diet. Another patient is 8 months from initial treatment and has no dysphagia. One patient died of aspiration of gastric tube feedings and 3 others died of their disease at 3 weeks, 3 months, and 6 months, respectively, from their initial treatment. Another patient died 11 months from his initial treatment due to a cardiac arrhythmia. During the 11 months after his initial treatment he continued to eat a regular diet.
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PMID:Palliation of esophageal malignancy with photoradiation therapy. 620 94

A single dose of thiopental (37-42 mg/kg) sufficient to achieve anesthesia induction increased the growth rate of a 3-methylcholanthrene-induced syngeneic murine fibrosarcoma in C57B1/6 mice. While no alterations in in vitro growth kinetics of tumor cells cultured with thiopental could explain these data, significant alterations in cell-mediated immunity were observed. Spleen cells from C57B1/6 mice treated with thiopental were impaired in their ability to respond in a mixed leukocyte culture (MLC) to BALB/c stimulator cells. Spleen cells from thiopental-treated mice suppressed the ability of cells from untreated animals to respond in a third-party MLC. The degree of suppression was directly proportional to the number of cells from thiopental-treated mice in the third party. When these cells were added to an MLC at various times during the culture period, suppression of the early phases of the MLC was seen. Removal of plastic adherent cells from the third party resulted in loss of suppression, but treatment of third-party cells with anti-thy 1.2 serum or irradiation did not prevent suppression. Transfer of spleen cells from thiopental-treated mice enhances growth of the B-16 melanoma. Suppressor-cell activity may be one mechanism by which thiopental promotes tumor growth.
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PMID:Suppressor cells and increased primary tumor growth rate induced by thiopental. 621 46

The modalities used to diagnose choroidal melanoma are described. The use of these procedures has reduced the misdiagnosis rate from 20% in the 1960s to less than 5% today. Observation and reinvestigation of small tumours is recommended. Surgery may cause dissemination of tumour emboli, which may be prevented by gentle handling of tissue, use of intravenous mannitol and hypotensive anaesthesia. Measures other than enucleation are available to treat choroidal melanoma, but few tumours meet the criteria for their use.
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PMID:Clinical management in the face of the uveal melanoma controversy. 648 80


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