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

The prognostic value of the TNM classifications of the UICC dated 1978 and 1987, was investigated in a population of 2,495 patients who were followed up over the long term. In the case of primary melanoma, Breslow's tumour thickness proved to be the most powerful predictor of patient survival in multivariate analysis, while the significance of Clark's level ranged after that of both localisation of the primary tumour and the sex of the patient. The continuous proportional relationship between tumour thickness and risk of death makes it possible to regrade thickness groups. Grading cutoffs at 1, 2 and 4 millimetres, with no account being taken of depth of invasion, proved to be particularly favourable for a classification in accordance with prognostic criteria. In advanced stages of the disease, the outcome of locoregional and distant metastasis is significantly different; and furthermore in the case of locoregional metastasis, in-transit and satellite metastases exert a significantly better prognosis than regional lymph node involvement. Isolated juxtaregional lymph node metastases occurred primarily or during the course of the observation period in only 19 patients of our group, and, in comparison with visceral metastases, proved to have only an insignificantly better prognosis. For this reason, it would appear meaningful to assign them to a common stage. On the basis of these results, proposals are made for modifications of the TNM classification.
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PMID:The prognosis of primary and metastasising melanoma. An evaluation of the TNM classification in 2,495 patients. 141 27

A retrospective review of 891 patients with newly diagnosed primary cutaneous malignant melanoma (CMM) registered at the British Columbia Cancer Agency from 1972 to 1981 is presented. Age-standardized incidence rates in British Columbia have increased markedly over that time. The female-to-male ratio was 1.13:1 and the median age overall was 47 years. A change in the size of a mole was the most common presenting sign (in 43% of patients) and the median duration of signs was 5.9 months. Predominant tumour sites were the trunk for males and the lower limbs for females. Dominant growth patterns were superficial spreading melanoma (65%), nodular melanoma (25%), lentigo maligna melanoma (5%) and acral lentiginous melanoma (2%). On staging of the primary tumour, 90% of patients had local disease, 9% of patients had regional disease and 1% of patients had distant disease at presentation. Median depths of tumours were 1.45 mm for males and 1.10 mm for females; no T1 tumours (tumours 0.75 mm or less in depth [TNM classification]) were staged beyond the local area. Disease recurred in 44% of males and 32% of females. The 15-year survival rate was 55.5% for males and 70.3% for females. These findings are compared with those of recent international series. It is apparent that earlier diagnosis improves survival and that more education is needed in view of the increasing incidence and death from CMM.
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PMID:Primary cutaneous malignant melanoma: experience of the British Columbia Cancer Agency from 1972 to 1981. 145 84

The prognostic value of cellular DNA content of melanoma metastases was investigated in tumours from 114 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. Thirty-six percent of the tumours were diploid and 64% aneuploid. For 91 patients the S-phase fraction was calculable. Tumour ploidy and S-phase fraction (SPF) were shown by multivariate Cox model analysis to be independent prognostic variables and major determinants of survival after first recurrence. Patients with either aneuploid or low SPF tumours survived longer than did those with diploid or high SPF tumours. By combining DNA ploidy and SPF, three types of DNA histograms could be defined, associated with favourable, intermediate and poor prognosis. Patients with aneuploid, low SPF metastases showed a median survival of 57 months, whereas the high-risk group with diploid, high SPF metastases survived only 13 months. When ploidy, SPF, age, sex, TNM stage and duration of disease-free survival were analysed as covariates the division of flow cytometry histograms into these three types resulted in the most significant prognostic factor (p < 0.001) in the Cox multivariate analysis.
Melanoma Res 1992 Nov
PMID:Improving the prognostic value of DNA flow cytometry in metastatic melanoma by combining ploidy and S-phase fraction. 149 Jan 12

The prognostic value of flow cytometric parameters and tumour growth rate of melanoma metastases under the mouse renal capsule was investigated for tumours from 117 consecutive patients referred to the Helsinki University Central Hospital Melanoma Team. DNA flow cytometry (FCM) was interpretable for the tumours of 114 patients, and growth rate analysis for 82 patients, both results being available from 79 patients. Thirty-six percent of the tumours were DNA diploid and 64% DNA aneuploid. Tumour ploidy and S-phase fraction were shown by multivariate Cox model analysis to be independent prognostic variables and major determinants of survival after first recurrence. Patients with DNA diploid or aneuploid tumours survived a median 16 and 27 months, respectively. A high growth rate of tumour sample in vivo under the mouse renal capsule tended to be a sign of poor prognosis, although not reaching statistical significance. Combining the results of FCM, tumour growth rate and TNM stage, we propose a highly efficient prognostic scoring method. Patients with a score above 0.75 had a median survival of 11 months compared to 30 months among patients scoring under 0.75 (P less than 0.0001). This score was the most significant (P less than 0.0001) prognostic factor in the Cox model when TNM stage, age, ploidy, SPF, and tumour growth rate were analysed as covariates.
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PMID:Tumour growth rate and DNA flow cytometry parameters as prognostic factors in metastatic melanoma. 152 May 90

Coumarin (1,2-benzopyrone) as a daily oral dose of 50 mg was evaluated in a multicentre prospectively randomized, double-blind, placebo-controlled trial to prevent early recurrence of malignant melanoma TNM Stage IB (Breslow thickness greater than 1.70 mm) and Stage II. Intake for the trial started in 1984 and was stopped prematurely, after review, in 1987. There were two recurrences in 13 treated patients and 10 in 14 controls which was significant (P 0.01). The sites of the metastases differed in each group, being local and in bone in the treated group, and in lymph nodes, skin and lung in the control group. There were no toxic effects associated with coumarin treatment and all patients without recurrence are now receiving coumarin.
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PMID:Prevention of early recurrence of high risk malignant melanoma by coumarin. Irish Melanoma Group. 267 9

Satellite nodules are considered to be predictive of poor prognosis in breast cancer and in melanoma. In lung cancer, there is no information as to their definition, prevalence, or implication as a prognosis factor of survival after resection. Over the past 18 years (1969 to 1987), 84 patients underwent pulmonary resection for primary lung cancer accompanied by satellite nodules. These nodules were defined as well-circumscribed accessory carcinoma foci clearly separated from the main tumor but with identical histologic characteristics. All were smaller than the primary carcinoma and most were located within the same lobe. Survival rates of patients with satellite nodules were compared to those of 1021 patients without satellite nodules who underwent resection during the same time interval. The 1-, 3-, and 5-year survival rates for all patients classified as having no satellite nodules were 78%, 54%, and 44%, respectively, and the median survival for the entire group was 30 months. In patients with satellite nodules, these survival rates were 60.9%, 32.7%, and 21.6%, respectively, with a median survival of 15 months. The deleterious effect of satellite nodules was more significant in patients with stage I disease (p = 0.0008) than in patients with stage II (p = 0.0354) or stage III (p = 0.0145) disease. Survival data obtained by comparison of satellite nodule status and histologic characteristics shows that 5-year survival figures are better for patients with no satellite nodules in both the squamous and the nonsquamous groups. This study demonstrates that satellite nodules associated with lung cancer are indicative of locally advanced and/or premetastatic disease. These patients should be included in the stage group IIIa of the TNM stage grouping classification.
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PMID:Carcinoma of the lung. Evaluation of satellite nodules as a factor influencing prognosis after resection. 292 56

We reviewed photographs of 256 primary cutaneous melanomas to determine the gross morphological correlates of metastases. Seven and a half years after diagnosis, the melanomas with ulceration occupying at least 80% of their surface had the highest rate of metastases (85%), and melanomas without a nodule had the lowest metastatic rate (11%). Melanomas with nodules had a metastatic rate of 62%, and this rate increased in direct proportion to nodule diameter. Even after adjusting for nodule diameter and ulceration, melanomas with single nodules located completely within the confines of an associated plaque had half of the metastatic rate of melanomas with nodules located at the periphery (abutting normal skin). These data suggest that (1) carefully recorded gross pathological data can augment the microscopic pathological data in the determination of prognosis; (2) skin lesions suspected to be melanoma should be photographed; (3) the photograph, if followed by surgical removal of the lesion, should be attached to the pathology report in the patient's permanent medical record; (4) nodule diameter is better correlated with metastases than the total lesion diameter (as traditionally held); and (5) the cytologically malignant melanocytes that constitute the less-raised portion of most melanomas may not be biologically malignant, thus enlarging the precursor concept for malignant melanoma. The TNM staging system for malignant melanoma could be modified to incorporate these data.
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PMID:Skin lesions suspected to be melanoma should be photographed. Gross morphological features of primary melanoma associated with metastases. 710

This is the case report of a 63 year old female patient, who was admitted to the hospital due to an unexplained anemia. A malignant melanoma of the cheek was excised four years previously (stage II, Clark level V, TNM classification: pT4, pNl, MO), followed by chemotherapy. By x-ray and CT examination an intestinal malignant growth was assumed. Laparotomy revealed a metastasis of the malignant melanoma, situated in the middle of the jejunum as cause of the occult bleeding. Complete resection of the tumor was successfully carried out. A second look laparotomy one year later revealed no further tumor growth in the abdominal cavity.
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PMID:[Metastasis to the small intestine of malignant melanoma as a rare cause of intestinal hemorrhage]. 794 1

Both coumarin (1,2-benzopyrone) and warfarin (4-hydroxycoumarin) have been shown to prevent the recurrence of malignant melanoma. Their action is macrophage-dependent and the dosage is critical. In 1984 a multicentre, prospective, randomised, double-blind trial of coumarin, given as a daily 50-mg dose for 2 years after surgery in patients with high-risk melanoma, was started. the patients had lesions greater than 1.70 mm thick and TNM stage IB or stage II disease. To date there are 4 recurrences in the coumarin-treated group of 13 patients, and 10 recurrences in the placebo-treated group of 14 patients (P < 0.01). There were no toxic effects.
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PMID:Treatment with coumarin to prevent or delay recurrence of malignant melanoma. 813 1

The frequency of malignant melanoma is increasing worldwide and comprises in middle Europe about 10 per 100,000 inhabitants per year; it is fatal in each forth or fifth patient. Risk factors may be endogenous, like fair skin with high sensitivity for sun exposure and the presence of many, possibly atypical ('dysplastic') naevi, or exogenous, e.g. excessive exposure to ultraviolet light. The superficial spreading malignant melanoma is the most common form of clinical manifestation. Applying the A (asymmetry), B (border), C (color), D (diameter), E (elevation) rule is a reliable help for making the diagnosis of malignant melanoma. The differential diagnosis besides various naevi comprises a wide spectrum of pigmented new formations of the skin. Classification of malignant melanoma follows the TNM system; spread, tumor thickness and/or level of infiltration are appropriate parameters. The most important prognostic parameter is tumor thickness, which results in 10-year survival time of only 30% if it exceeds 3 mm. The therapy of malignant melanoma is performed by excision with margins between 1 and 3 cm, depending on tumor thickness. Frequency and type of investigations for follow-up controls depend on the risk for metastases, i.e. on tumor thickness. Best prevention is achieved by avoiding excessive exposure to ultraviolet light, especially during childhood, and by early diagnosis of thin melanoma.
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PMID:[Malignant melanoma of the skin]. 817 4


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