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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This essay places the concept of "primary acquired melanosis" of the conjunctiva in historical perspective and shows that it and its analogs, namely, lentigo-melanosis (Hutchinson), melanotic freckle (Hutchinson), melanose circonscrite precancereuse (Dubrueilh), melanotische precancerose (Miescher), lentigo maligna (Clark), precancerous melanosis (Reese), benign, precancerous, and cancerous melanosis (Zimmerman), atypical melanocytic hyperplasia (Silver et al.), and benign acquired melanosis (Zimmerman), are synonyms for melanoma in situ. The issue is not merely semantic or philosophical; it is urgently practical. If a clinician takes literally the meaning of a lesion designated "benign melanosis" and considers it to be benign, rather than the malignant melanoma that it actually is, a patient who bears that flat pigmented lesion may one day die of metastasis from an elevated sequella of it. The same is true of "primary acquired melanosis," which is not simply a condition of blackening by melanin, but a flat melanoma that, if not removed completely, may give rise one day to metastases that cause death. To avoid such misconstructions, we advocate naming melanomas in all organs "melanoma" and those that are confined to epithelial structures "melanoma in situ." Euphemisms like lentigo maligna and primary acquired melanosis are evasions of the diagnosis of melanoma, and use of them may be harmful. For that reason, they should be eschewed.
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PMID:Primary acquired melanosis of the conjunctiva is melanoma in situ. 149 53

We report an additional case of diffuse melanosis secondary to metastases from malignant melanoma in a patient, who was seen in our department shortly before death. We couldn't localize the origin of the primary neoplasm. After reporting the case, we discuss the pathogenesis of melanosis and possible sites of the primary tumor.
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PMID:[Diffuse melanosis in metastatic malignant melanoma with melanuria]. 210 51

A case of amelanotic malignant melanoma of the esophagus in a 76-year-old woman is reported. A whitish polypoid tumor, measuring 3 x 2 x 2.7 cm, surrounded by black pigmented mucosa, was detected in the middle intrathoracic esophagus. The tumor showed a lobulated surface lined by squamous cell layer, and had epithelioid and polyhedral cells forming alveolar clusters. Melanin pigments or stainability for the dihydroxyphenylalanine (DOPA) reaction were only observed in a few tumor cells. Junctional changes and mucosal melanosis, however, were found freely in the mucosa around the tumor. Many tumor cells showed a strongly positive immunohistochemical reaction for neuron specific enolase (NSE) and S100 protein. The patient died of widespread metastases six months after surgery. Further, a review of 106 reported cases of primary esophageal malignant melanoma, including 29 autopsies, was made; the melanomas were found to include 10 of amelanotic type, eight of which had been misdiagnosed at biopsy. Junctional changes could be found in the mucosa over or around the tumor, in four cases, and mucosal melanosis in one. Lymph node metastasis was the most frequently observed development at autopsy regardless of whether the tumor was amelanotic or melanotic. For correct diagnoses of melanomas of the amelanotic type, peripheral mucosal findings, such as junctional changes or melanosis, should be helpful; and, in order to obtain a good prognosis, a careful resection of the regional lymph nodes could prove valuable.
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PMID:Amelanotic malignant melanoma of the esophagus: case report and review of the literature. 225 5

Eighty-one cases of conjunctival melanoma treated between 1960 and 1988 were studied to determine factors that might affect outcome in patients with such lesions. The therapeutic procedures performed were local excision (16), local excision followed by brachytherapy with Sr-90/Y-90 (32), local excision followed by cryotherapy with liquid nitrogen (16), brachytherapy with Sr-90/Y-90 (12), local excision followed by external beam irradiation (3), and local excision followed by brachytherapy and cryotherapy (2). The median follow-up period was 5.5 years (longest 26, shortest 1 year). Sixty two patients (76.5%) showed a complete regression of the melanoma, 19 (23.5%) developed recurrences, and 15 (18.5%) died from metastases. The melanomas had developed with almost equal frequency from a pre-existing naevus (25.9%), from primary acquired melanosis (25.9%), and 'de novo' (30.9%). Small tumours had a higher chance of regressing (80.6%) than larger ones (68.6%). The cumulative survival rate was 76% after five years and 60% after 10 years from any causes of death and 87.6% after five years and 76.3% after 10 years from deaths caused by metastases. Most deaths from metastases occurred within 5 years. At 88.5%, the cumulative survival rate of patients with small tumours (less than one quadrant of the bulbar conjunctiva and less than 2 mm thickness) was significantly higher than that of patients with larger tumours (more than one quadrant of the bulbar conjunctiva and/or more than 2 mm thickness) with 65% after eight years. Local excision followed by beta ray irradiation (Sr-90/Y-90) or cryotherapy can be recommended as the treatment of choice. Nevertheless the behaviour of conjunctival melanomas remains unpredictable in individual cases.
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PMID:Therapeutic outcome of patients suffering from malignant melanomas of the conjunctiva. 228 86

Four patients had malignant melanoma involving the conjunctiva, nasal cavity, and paranasal sinuses. In each patient, the conjunctival melanoma preceded recognition of the lesion in the nasal cavity by months or years. Each patient had one or more conjunctival biopsy specimens that documented melanoma, and in each patient the melanomas evolved in primary acquired melanosis of the conjunctiva. Histologic examination of the epithelium adjacent to the tumor in the nasal cavity failed to show either atypia or diffuse melanosis. We believe that these melanomas in the nasal cavity and paranasal sinuses are most likely to evolve as regional metastases, although it is possible that they arise de novo or as related foci in accordance with the multicentric characteristics of conjunctival melanoma. If a patient with a conjunctival melanoma has symptoms referable to the nasal cavity or paranasal sinuses, ophthalmologists should refer the patient to an otolaryngologist.
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PMID:Malignant melanomas of the conjunctiva, nasal cavity, and paranasal sinuses. 280 64

Despite the frequency of cerebral metastases from melanoma, there have been very few papers on this subject in the radiological literature. We report one such case, original by its disseminated carcinomatosis appearance and by the disassociation between computed tomography and magnetic resonance imaging, illustrating the greater sensitivity of the latter examination. In view of the fact that 11 to 13% of patients with a cerebral metastasis from melanoma are asymptomatic, there may be a place for screening of these patients by MR imaging. The association of neurological lesions and cutaneous naevi raises the problem of neurocutaneous melanosis (degenerating phakomatosis).
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PMID:[The value of MRI in a case of cerebro-meningeal miliary carcinomatosis of melanotic origin]. 281 27

Sixty-two patients were treated by some combination of cryotherapy and surgery with an average follow-up of 3.3 years for one of the following diseases: focal or diffuse flat conjunctival primary acquired melanosis (PAM) with atypia but without a nodule of melanoma (10 cases); unifocal malignant melanoma with or without focal or diffuse PAM (30 cases); and multinodular/multicentric melanoma with and without PAM (22 cases). Of the ten patients who had PAM with atypia, invasive nodules of malignant melanoma did not develop. A second treatment was required to control the disease in four of the ten patients with extensive or diffuse lesions, and one has mild persistent disease. Of the 30 patients with unifocal nodules of malignant melanoma, 27 remained free of recurrence after one treatment, and 2 are asymptomatic after two treatments. One patient with a thick nodule at presentation required a parotidectomy and radical neck dissection for cervical metastases after recurrence in the conjunctival sac. In the group of 22 patients with multinodular malignant melanoma, only two did not have recurrent disease after one treatment. Of those who received multiple therapies, seven remained free of recurrence for at least 2 years after the last treatment; regional or distant metastases developed in nine; four required exenteration; and eight died. Conjunctival adjunctive cryotherapy avoids exenteration in extensive lesions of pure PAM and in unifocal melanoma, but even after multiple therapies, multinodular malignant melanoma had a 45% rate of metastasis. Metastasis was related to the presence of PAM sine pigmento in four patients (microscopically but not clinically detectable PAM); to the location of the nodules (9 of 10 patients who experienced metastases had forniceal, palpebral, and/or caruncular nodules); to the thickness or depth of invasion of the nodules (greater than 2 mm); and to the development of intralymphatic spread ("in-transit" local metastasis) within the conjunctival sac in six patients. No metastases were encountered among patients with strictly limbal nodules and among five patients with invasive nodules composed of spindle cells in part or in toto. Therapeutic success in this spectrum of melanocytic proliferations is closely correlated with the clinical extent of the disease when initiating definitive therapy.
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PMID:Cryotherapy for conjunctival primary acquired melanosis and malignant melanoma. Experience with 62 cases. 323 44

A patient suffering from a metastasizing malignant melanoma of the skin developed diffuse melanosis of the skin and melanuria a few weeks before death occurred. At autopsy, disseminated metastases of malignant melanoma were associated with marked melanosis of the organs and particularly of the mononuclear phagocytic system. In addition, neutrophilic granulocytes of the peripheral blood frequently contained melanin granules. The presence of melanin in blood monocytes and granulocytes may be useful for the diagnosis of (metastasizing) malignant melanoma.
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PMID:[Generalized melanosis of macro- and microphages in metastasizing melanoma]. 359 91

Proptosis and ptosis, caused by a large orbital mass that was excised and determined to be malignant melanoma, developed in a 4-year-old girl with congenital neurocutaneous melanosis (multiple large or giant cutaneous nevi associated with abnormal leptomeningeal pigmentation). Shortly thereafter, the patient had evidence suggestive of systemic metastases and died. The orbital tumor was likely metastatic from a primary meningeal melanoma. Other possible sources of metastatic tumor are discussed. It is unlikely that this was a primary orbital melanoma because the patient had no clinical or pathologic manifestations of pre-existing oculocutaneous melanosis, orbital melanosis, or orbital blue nevus.
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PMID:Congenital neurocutaneous melanosis with metastatic orbital malignant melanoma. 380 23

One hundred thirty-one cases of conjunctival melanoma in which biopsies had been performed were studied to determine potential factors that might affect outcome in patients with these lesions. Two groups of lesions were identified: those associated with primary acquired melanosis (melanoma with PAM, 98 cases, 74.8 per cent) and those without primary acquired melanosis (melanoma without PAM, 33 cases, 25.2 per cent). The overall mortality rate in the 131 cases was 26 per cent (34 of 131); the mortality rate due to melanoma with PAM was 25.5 per cent (25 of 98), and that due to melanoma without PAM was 27.3 per cent (9 of 33). If PAM was associated with the lesion, the presence of atypical melanocytes within the epithelium (pagetoid invasion) was a sensitive indicator of subsequent metastasis. Tumor thickness may also be useful for predicting subsequent metastases. None of the histologic parameters studied proved useful for predicting outcome in patients who had melanomas without PAM. The presence or absence of nevi had no effect on prognosis.
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PMID:Malignant melanoma of the conjunctiva. 397 96


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