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

The incidence of metastasis in cutaneous melanoma is proportional to maximal tumor thickness. The relationship is linear for extremity melanoma but not for tumors from all body sites, probably due to intrinsic differences in tumors from different sites. The level of invasion of the tumor is an indirect measure of tumor thickness and is not as accurate in predicting metastases because of the marked variation in thickness within each level. The implications of these observations for the treatment of melanoma are discussed.
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PMID:Prognostic factors in the treatment of cutaneous melanoma. 47 39

Cutaneous malignant melanoma occurs in three forms: lentigo maligna melanoma, superficially spreading melanoma, and nodular melanoma. The histology, the clinical development and the biological malignancy of these tumours differ. The purpose of the study reported here was to provide a clearer picture of the surface morphology of the malignant cells and to relate their fine structure to both the tumour type and the clinical development of the malignant melanoma. This investigation of 28 tumours from 22 patients of Scandinavian origin shows that at the electron microscope level there is no difference between malignant cells in the invasion nodulus of superficially spreading melanoma and nodular melanoma. The primary tumours were often built up of 2 or 3 differently differentiated cell clones. Metastases were built up of the same cells or cell clones that were found in the primary tumour. In several cases the surface of the malignant cells was folded, and covered with microvilli, microblebs and blebs. These surface alterations could be related in several cases to changes in the cytoskeleton of the cell (microtubuli and microfilament complexes). The clinical course of the malignant melanoma could best be correlated to the histogenetic type of tumour, depth of invasion, nucleus polymorphy and the quantity and arrangement of the microfilament complexes.
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PMID:Cutaneous malignant melanoma. Studies on the find structure of cells and their surface morphology in relation to tumour type and clinical course. 54 76

The neoplastic system of human cutaneous melanoma includes three generaly recognized variants: lentigo maligna, superficial spreading melanoma, and nodular melanoma. Lentiginous melanomas other than lentigo maligna constitute a fourth group, of which plantar lentiginous melanoma qualifies as an anatomic subgroup. Histologically and clinically, plantar lentiginous melanoma (PLM) is characterized by a period of radial growth and often by one or more foci of regression. In 27 of 33 plantar melanomas, a characteristic lentiginous, radial component of melanocytic proliferation was noted. In the remaining six cases, histological material failed to document a radial component. Eighteen of the 27 patients with PLM were blacks, and 18 patients died of distant metastasis. Tumors invasive to level II did not metastasize, but at levels IV and V and in tumors with a high mitotic rate, the prognosis was poor. The presence of lymph node metastases at the time of initial therapy correlated with a poor prognosis group.
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PMID:Plantar lentiginous melanoma: a distinctive variant of human cutaneous malignant melanoma. 60 75

A review of the literature on melanoma indicates that age, sex, size, ulceration, presence of satellites, absence of melanin, and whether or not the tumor is markedly raised above the surface of the surrounding skin are all useful criteria in evaluating the prognosis in Stage I cutaneous melanoma. Histological factors include the tumor type, the mitotic rate, and the maximum thickness of the tumor. The last is accurate for prognosis--objective, reproducible, and directly proportional to the mortality rate. Tumors less than 0.76 mm thick rarely, if ever, metastasize--and it appears that the size of the resection margin can safely be reduced for such thin tumors. The level of invasion (Clark) is less accurate in predicting the mortality.
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PMID:Evaluation of prognosis in Stage I cutaneous melanoma. 1475 44

A retrospective study was undertaken of 146 surgically treated subjects with primary cutaneous melanoma of which 73 were disease-free for five to nine years and 73 developed later metastases. A prognostic factor was south to determine patients with poor prognoses. The best overall method was shown to be the evaluation of the prognostic index defined as the product of tumor thickness and the number of mitoses per square millimeter. However, for establishing a group of patients with no incidence of metastases, the mitotic rate proved to be as good a factor as the prognostic index and better than tumor thickness or levels of invasion. The application of this prognostic index seems therefore to be useful in selecting for further treatment stage I melanoma patients with poor prognoses, eg, prophylatic lymph node dissection and immunochemotherapy.
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PMID:Prognostic index in malignant melanoma. 66 22

In the past, surgical treatment of cutaneous melanoma has been determined largely by assessment of the regional nodes by clinical palpation. More recently, an increasing number of reports indicate that measurement of the histologic thickness of primary melanomas and evaluation of the level of penetration of tumor cells into the dermis can predict the likelihood of development of nodal metastases. In addition performance of fine needle aspiration of questionably involved regional nodes has provided cytologic data regarding nodal metastases. The role of certain procedures, such as prophylactic (elective) node dissection remains clouded because adequate numbers of properly controlled studies have not been reported. However, increasing knowledge of important prognostic factors, cytologic findings from needle aspiration of regional nodes, as well as the clinical assessment of regional nodes, can all aid formulation of more rational management recommendations.
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PMID:Surgical management of advanced cutaneous malignant melanoma. 76 94

Sixty melanoma patients were followed 20 to 30 years after primary therapy, and survival rates were reviewed with reference to clinical and histological staging. All but one of the patients with clinically positive regional nodes died of metastatic disease. Two of nine patients with nonenlarged nodes that were clinically negative but histologically positive are alive 25 years after node dissections. Ten of 17 patients with negative nodes survived their operations by 20 to 30 years. Another series of 138 patients with stage 1 cutaneous melanoma were reviewed at the George Washington University Medical Center and tumor thickness was found to be a better measurement of prognosis than clinical or histologic staging, or the tumor's level of invasion. Prophylactic lymph node dissection appeared to double the survival of patients with lesions greater than 1.5 millimeters thick, but had no effect on those with thinner lesions. Thirty-nine per cent of the patients had lesions less than 0.76 mm thick, and all survived free of disease for five or more years. Of the tumors in the intermediate range of 0.76 to 1.50 mm thick, 33% metastasized or recurred; no clinical or pathologic discriminant could be detected that differentiated those patients who would have the recurring lesions from the others with tumors in this range of intermediate thickness who did well.
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PMID:Malignant melanoma: correlation of long-term follow-up with clinical staging, level of invasion and thickness of the primary tumor. 83 3

A retrospective review from 1935 to 1962 of 772 melanomas involving the head and neck seen at the Pack Medical Foundation (PMF) is presented with the main emphasis of 660 cutaneous and mucosal melanomas. Clark's levels for pathologic invasion are presented and correlated to 289 cases with 19 percent in Level II and 81 percent deeply invasive at Level III, IV, and V. The face was the most commom location with the cheek alone accounting for 22.3 percent of all the cases. The male to female ratio was 1.5 to 1 with 76 percent of the cases being equally distributed among the fourth through the seventh decades. 55.9 percent were local disease, Stage I, with 33.5 percent, Stage II, and 10.6 percent, Stage III or distal disease. The five-year or greater absolute cure rate in positive nodal disease was 12.6 percent. Elective versus no elective neck dissection in Stage IA disease demonstrated a five-year or greater absolute cure rate of 55 percent as compared to 38.5 percent. Distal metastases occurred in 30 percent of cases with elective neck dissection but in 70 percent of those cases with therapeutic neck dissection. The absolute five-year or greater cure rate was able to be analyzed in 556 cases. The rate was 25.6 percent for the mucosal and cutaneous lesions combined; an 8 percent rate for mucosal alone and 27.8 percent for cutaneous melanoma. The five-year or greater absolute cure rate for those cases treated totally at PMF was 35.4 percent.
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PMID:Melanoma of the head and neck. 85 Apr 50

A prospective protocol for the management of primary cutaneous melanoma was initiated at the University of Illinois in October 1968 and continued through June 1974. Over this period 269 cases were treated: 42 of the head and neck region, 75 of the trunk, 94 of the lower extremities and 58 of the upper exremities. The levels of invasion ranged from II to V, according to Clark's classification; level I melanomas were excluded. The status of the regional nodes was correlated with the level of invasion. Preliminary exploratory celiotomies were performed on all patients with lower extremity melanomas and on all those with level IV or V melanoma with clinically positive regional nodes. All patients were treated with wide excision and elective regional node dissection except those in whom celiotomy showed disseminated disease. Of the 150 patients now eligible for five-year analysis, 33 had level II disease, three with positive nodes. None had local recurrence or intra-abdominal metastasis. All 33 (100%) were cancer-free at five years. Of 56 with level III, 23 had positive regional nodes, two had local recurrence within two years, and two with melanoma of the lower extremities had intra-abdominal metastases. At five years 53 (95%) of the 56 were cancer-free. Of the 42 with level IV, 31 had positive regional nodes, five had local recurrence and five had intra-abdominal metastases; 21 (50%) survived for five years. Of the 19 with level V, 17 had positive nodes, three had local recurrence and five intra-abdominal metastases; 7 (37%) were five-year survivors. Of the 150, 114 (76%) were cancer-free at five years. On the basis of these findings, it was concluded that wide local excision is adequate for level II and probably for thin level III. But for thick level III and levels IV and V the best salvage rate is obtained by an aggressive surgical approach.
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PMID:Results of treatment of 269 patients with primary cutaneous melanoma: a five-year prospective study. 88 65

A patient with isolated metastases from cutaneous melanoma to the gall-bladder is reported. The patient presented clinically with obstructive cholecystitis. The course of melanoma is unpredictable and the possibility that an apparently unassociated condition is due to metastases should always be considered. Isolated metastases may respond well to radical surgery and reward the surgeon's efforts.
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PMID:Obstructive cholecystitis due to metastatic melanoma. 101 2


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