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

Between October 1988 and September 1991, 60 patients with cutaneous metastases from malignant melanoma have been treated palliatively using carbon-dioxide laser ablation. The number of lesions per patient varied between 3 and 450; accordingly treatment was performed under local or general anaesthesia. The post-operative complication rate was low and the majority of wounds healed within 6 weeks. Control of in-transit metastatic disease and palliation of disseminated cutaneous melanoma can be achieved by carbon-dioxide laser ablation which provides a simple and effective alternative to isolated limb perfusion. Eighteen of the 32 patients in this series with stage IIIa disease were controlled by three or fewer laser treatments in the first year. We advocate laser vaporization as the initial treatment for non-nodal regional recurrence in the knowledge that isolated limb perfusion can be offered at a later stage for patients who cannot be controlled by the laser.
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PMID:Treatment of cutaneous metastases from malignant melanoma using the carbon-dioxide laser. 849 21

During the past decade more than 90% of all melanoma patients in the German-speaking countries have been diagnosed with a primary tumour alone. Therefore, surgical intervention has been the most important element in the management of these patients. The present investigation was performed to analyse the different surgical procedures used in the treatment of primary melanoma during the years 1983-1993. The primary treatment of 15,054 patients with malignant melanoma and without recognizable metastasis has been examined. During the time period under investigation the percentage of cases treated with two-step surgical management increased from 30% to 60%. Primary excision was performed in local anaesthesia in 40% of all patients in 1983, whereas in 1993 surgical intervention under local anaesthesia had increased up to 80%. Over the same time, the average safety margin decreased from 33 mm to 21 mm for the final excision of primary melanomas, and this decrease was paralleled by marked decrease in the average thickness of the tumours excised from 2.1 to 1.5 mm. Elective node dissection was performed in 5% of all patients in 1983, whereas 9% of patients underwent elective node dissection in 1993. The different centres participating were found to differ noticeably in the therapeutic procedures applied for similar indications. In conclusion, the management of primary malignant melanoma has changed considerably during the years 1983-1993 in the German speaking area in favour of a two-step surgical procedure, local anaesthesia for the excision of the primary tumour and smaller safety margins. It seems that earlier diagnosis of the tumour and also ideas about treatment design may be responsible for these changes.
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PMID:[Management of primary malignant melanoma of the skin in German-speaking countries 1983-1993. A study of the Malignant Melanoma Central Register of the German Society of Dermatology]. 864 82

Between October 1988 and November 1994, 100 patients with cutaneous metastases from malignant melanoma were treated by carbon dioxide laser ablation under local or general anaesthesia as appropriate. There were minimal postoperative complications and most wounds healed within 6 weeks. A total of 34 of the 53 patients in this series with stage IIIa disease were controlled with four or fewer laser ablations during the first year from presentation. This technique provides a simple effective alternative to hyperthermic isolated limb perfusion with melphalan. Patients with disease not controlled by laser can be considered for isolated limb perfusion.
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PMID:Use of the carbon dioxide laser to manage cutaneous metastases from malignant melanoma. 866 45

Hyperthermic isolated limb perfusion (ILP) with melphalan is an accepted method of treatment for advanced or recurrent melanoma on a limb. In a review of 124 patients who underwent 130 ILPs at the Sydney Melanoma Unit, the anaesthetic considerations are summarized. All patients received general anaesthesia. The level of monitoring is discussed and monitoring of the limb venous pressure is important to minimize major fluid shifts between the systemic vasculature and the vascular compartment of the isolated limb and extracorporeal circuit.
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PMID:Anaesthetic experience with isolated limb perfusion with melphalan for melanoma. 888 62

Primary malignant melanoma of the conjunctiva is an uncommon neoplasm comprising only 2% of the malignant tumors of the eye. The tumors are usually composed of epitheloid, spindle or mixed cells and classified according to the predominant cells. Recently we encountered a conjunctival malignant melanoma occurring in a man. After full clinical and laboratory investigations, a clinical diagnosis of malignant melanoma of the conjunctiva in the left eye was entertained. The tumor was resected under local anesthesia and upon histological examination, the case was confirmed as a conjunctival malignant melanoma. Approximately one month after resection, orbital exenteration was carried out. The patient was followed-up for more than a year with no signs of metastasis or recurrence.
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PMID:Epitheloid cell malignant melanoma of the conjunctiva. 892 37

Skin biopsies provide physicians with valuable information in the evaluation of many dermatologic conditions. Before beginning the biopsy, family physicians should understand a few guidelines regarding the choice of the lesion to be sampled. These guidelines help the physician avoid unnecessary scars and ensure optimal pathologic correlation. The most common techniques include the punch, shave, excisional and incisional biopsies. Each procedure has advantages and disadvantages, depending on the dermatologic condition and the morphology of the lesion. Pigmented lesions characteristic of melanoma require special consideration. Techniques of skin preparation, tissue handling, anesthesia and equipment are presented.
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PMID:Principles of skin biopsies for the family physician. 896 42

In vivo experiments were performed to evaluate the effect of fluence rate on the efficiency of Zn(II)-2,3 naphthalocyanine (ZnNc) photosensitization of B16 pigmented melanoma subcutaneously transplanted in C57B1/6 mice. The tumour was irradiated with 774 nm light at 24 h after an injection of liposome--which incorporated ZnNc (0.5 mg kg-1 b.w.). A total light dose of 360 J cm-2 was delivered at fluence rates of 260, 320, 380, 440 and 500 mW cm-2. Separate groups of mice utilized to monitor tumour temperature changes during irradiation without or after anaesthesia. Tumour response was determined by measuring the mean tumour diameter of the treated towards the untreated animals for a period of 21 days following PDT, as well as the percentage of cured animals. The most promising result (40% complete tumour response) was obtained with anaesthetized mice following 380 mW cm-2. Higher dose rates (440 and 500 mW cm-2) led to less promising results for both anaesthetized and non anaesthetized mice. These results outline the potential of PDT with longer wavelengths for the treatment of highly pigmented tumour tissues. The optimal fluence rate for tumour treatment should be chosen in order to avoid inflammatory effects (tissue swelling) and oxygen suppression with sublethal injury to the tumour cells.
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PMID:Fluence rate effects on photodynamic therapy of B16 pigmented melanoma. 904 2

The role of enucleation in the treatment of ocular melanoma has been questioned by those who believe that it may increase circulating melanoma cells, increasing the incidence of metastases. Some aspects of the immune system are depressed by general anaesthesia, therefore this study was initiated to assess the effect of general anaesthesia on natural killer (NK) cell and interleukin-2 (IL-2)-activated cytotoxicity in 19 patients using 51Cr-labelled target cells (K 562 and SW 742). NK cytotoxicity was increased at induction and during the operation which was due to significant increases in female, but not male patients. At 1 week post-surgery, female patients had decreased NK cytotoxicity compared with males at this interval. NK cytotoxicity compared with males at this interval. NK cytotoxicity was increased intra-operatively when alfentanyl was used, and if the mean tumour diameter was > 15.0 mm the NK cytotoxicity was increased intra-operatively compared with that in patients with smaller tumours. IL-2-stimulated cytotoxicity was reduced at 1 day post-surgery in females only. There was an increased IL-2-stimulated cytotoxicity at induction when propofol was used and IL-2-stimulated cytotoxicity was reduced at 1 week post-operatively if the patient's mean tumour diameter was > 15.0 mm. If NK cell and lymphokine-stimulated cell cytotoxicity are involved in limiting metastatic disease, the patient' sex and tumour size and the anaesthetic agent used may influence the survival rates following surgery.
Melanoma Res 1997 Apr
PMID:Natural killer and lymphokine-activated cytotoxicity following anaesthesia in patients with uveal malignant melanoma. 916 79

During isolated limb perfusion (ILP) severe metabolic impairment with a subsequent alteration in oxygen consumption can be observed. The mechanisms responsible for this may be extracorporeal circulation, hyperthermia, and application of cytostatic drugs and cytokines. Thirty-three patients underwent ILP with rhTNF alpha and melphalan for melanoma or soft-tissue sarcoma. Cardiopulmonary monitoring consisted of arterial and mixed venous blood-gas analysis and a Swan-Ganz catheter was inserted after induction of general anesthesia prior to any surgical intervention. Arterial (SaO2) and mixed venous (SvO2) oxygen saturation, serum lactate and end-expiratory CO2 concentration were determined peri- and postoperatively for 72 h. Oxygen supply and consumption rates were measured systemically (DO2I, VO2I) and in the extracorporeal circuit ('DO2I, 'VO2I). For statistical analysis we used the t-test. During extracorporal circulation an increase of DO2I and VO2I was observed. A slight increase of lactate values began during the wash-out phase. Immediately after reperfusion. DO2I, VO2I and lactate increased significantly with normalization until the 2nd postoperative day. SaO2 and SvO2 remained unchanged. A significant correlation between regional toxicity and the postoperative maximum of serum lactate values was found. The increase of DO2I and VO2I in the tissues during ILP and after reperfusion was achieved by a significant increase in cardiac output while the oxygen extraction rate was not altered. Elevation of lactate values after reperfusion and the increase in oxygen utilization might be due to oxygen depletion in the perfused limb. This could contribute to the development of lactacidosis or rhabdomyolysis. Therefore, to minimize toxicity it seems to be mandatory to measure adequate tissue oxygen supply during ILP.
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PMID:[O2 utilization during hyperthermic extremity perfusion with rhTNF alpha and melphalan]. 932 10

Some patients presenting with cutaneous malignant melanoma without palpable adenopathy have regional metastatic disease. We have applied the technique of gamma probe-directed selective lymph node biopsy and used the results to direct further therapy. The results of a prospective nonrandomized clinical study are presented. Between November 1993 and December 1996, 63 patients with a diagnosis of primary cutaneous malignant melanoma underwent lymphoscintigraphy with technetium sulfur colloid followed by gamma probe-guided lymph node biopsy. There were 32 (51%) women and 31 (49%) men with a mean age of 51.1 years (median, 50; range, 13-87). Mean Breslow thickness was 2.13 mm (range, 0.5-15.0 mm; median, 1.56 mm). Primary locations were head and neck in 8 (13%), trunk in 24 (38%), upper extremity in 13 (21%), and lower extremity in 18 (29%). Selective lymph node biopsy was done on an outpatient basis with local anesthesia in 49 cases (78%) and in the operating room with general anesthetic in 14 patients (22%). One lymph node site was biopsied in 46 patients (73%), two sites in 16 (25%), and three in 1 (2%), for a total of 81 selective lymph node biopsy sites, mean 1.29 per patient. The mean number of labeled lymph nodes removed per site per patient was 1.64 (range, 1-5). Seroma or infection occurred in 6 patients (10%). Micrometastatic disease was identified in nine selective lymph node biopsy sites in eight patients. Of eight patients undergoing lymph node dissection, 5 (63%) had no additional pathological lymph node involvement. With a mean follow-up of 579 days from selective lymph node biopsy (median, 594; range, 36-1157), 59 (94%) have no evidence of disease. Three patients have died, 2 with systemic disease (475 and 1149 days) and 1 from a myocardial infarction (380 days). No patient has failed with regional-only recurrence. Gamma probe-directed selective lymph node biopsy is a straightforward procedure that can be done in the outpatient setting and facilitates management of patients with cutaneous malignant melanoma.
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PMID:Prospective evaluation of selective lymph node biopsy for cutaneous malignant melanoma. 939 52


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