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

Cutaneous malignant melanoma sometimes metastasizes to the upper respiratory and digestive tracts. It may cause significant local symptoms such as airway obstruction and dysphagia, and, in some cases, may represent the initial manifestation of disseminated disease. Of the 8,823 patients with cutaneous malignant melanoma seen at The University of Texas-M.D. Anderson Hospital and Tumor Institute at Houston between 1944 and 1983, metastases to this region developed in 54 patients. The most common sites involved were the tonsil, tongue, nasopharynx, larynx, and lip. Five of ten cases in which an autopsy was performed were noted to have previously undiagnosed metastatic mucosal lesions. We conclude that metastases to the upper aerodigestive tract in patients with cutaneous malignant melanoma is a distinct possibility. Melanoma patients who manifest symptoms localized to this region should be carefully examined to exclude the possibility of metastatic tumor, since alternative treatment may be required. Local endoscopic treatment may be necessary to relieve airway or digestive tract obstruction.
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PMID:Upper aerodigestive tract metastases in disseminated malignant melanoma. 396 53

Frequently the primary lesion of high-risk cutaneous melanoma (level III, greater than or equal to 1.5mm; greater than or equal to 1.0 mm with ulceration) is in an ambiguous lymphatic drainage site on the trunk, pelvic and shoulder girdles, and head and neck area. Lymphoscintigrams were performed by a circumferential intradermal injection of the biopsy site using technetium 99m (99mTc) antimony sulfide colloid in a total dose of 0.2 to 0.6 mCi in a volume of 0.1 to 0.5 ml. Imaging was done with a large-field gamma camera with high-resolution parallel hole collimator. Technetium 99m antimony sulfide colloid is an ideal agent for lymphoscintigrams because of small particle size (3-30 micron), which permits early migration into the interstitial space and lymphatics and rapid pickup by lymph nodes. Although it is a gamma emmitter with high activity, it has a short half-life and does not induce tissue necrosis. It does not localize the site of lymph node metastases, but indicates only the drainage pattern. Images were obtained at 1, 5, 10, 15, 30, and 60 minutes, respectively, and then three times every hour. Surgery was usually performed 24 hours later. The majority of patients had lesions with ambiguous drainage sites: head and neck (4 of 5 patients) and trunk (9 of 13 patients). The drainage by scan was to unpredictive sites in 72%, and resulted in a change of treatment planning by location and extent of ablation with node dissection in 9 of 18 patients. Ambiguous dissection sites included: (1) question of preauricular dissection with parotidectomy versus posterior auricular and cervical dissection for selected scalp lesions; (2) low-neck with or without axillary dissection for upper chest and shoulder lesions; and (3) axillary versus groin dissections for midflank lesions at zone of ambiguity between axilla and groin. It was concluded that preoperative 99mTc antimony sulfide lymphoscintigraphy is a highly useful planning technique in determining the appropriate lymphatic drainage basin for dissection in selected melanoma patients.
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PMID:Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk. 397 11

In 1,283 patients with cutaneous stage I malignant melanoma who had ten or more years of follow-up, the incidence of late recurrence (first evidence of metastases occurring ten or more years after melanoma diagnosis) was 2.7%. None of the factors of prognostic importance (anatomic site, tumor thickness, ulcerative state of primary lesion, or initial surgical treatment) proved useful in predicting those patients with late recurrence. There was no sex or age difference in either incidence of late recurrence or prognosis subsequent to recurrence. Prognosis subsequent to late recurrence depended on the site of the recurrence. Survival after distant metastases became evident was extremely short. However, in the majority (53%) of patients, late recurrence was local and survival subsequent to treatment of these metastases was often protracted, emphasizing the importance of long-term follow-up in all patients with cutaneous melanoma.
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PMID:Late relapse from cutaneous stage I malignant melanoma. 403 58

To develop guidelines for the follow-up of patients with primary cutaneous melanoma (clinical Stage I), we studied 295 patients who had presented with a primary melanoma and who subsequently developed evidence of metastatic disease in the course of follow-up. Cox multivariate analysis was used to assess the influence of five variables in predicting the interval of time from the diagnosis of melanoma to the first clinical or laboratory evidence of metastatic disease (disease-free interval). The variables studied were tumor thickness, patient sex, patient age, elective lymph node dissection, and primary tumor location. Tumor thickness was found to be the major predictor of disease-free interval, which shortened progressively with increasing tumor thickness. Men had a shorter mean disease-free interval than women, although this effect did not reach statistical significance at the 0.05 level. Patient age, tumor location, and elective lymph node dissection were found not to be predictors of disease-free interval. The risk of recurrence of melanoma was tabulated, by year, for four intervals of tumor thickness. The increase in risk of recurrence associated with increases in tumor thickness above 1.5 mm was shown to occur predominantly in the early years following diagnosis-particularly in the first year. On the basis of our findings, we have suggested regimens of follow-up for melanoma.
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PMID:Frequency and duration of patient follow-up after treatment of a primary malignant melanoma. 407 70

Second primary cancers were studied in persons with rare tumors between 1943 and 1980. The risk of developing a new cancer was evaluated in 7,211 persons with cutaneous melanoma, 1,784 persons with eye cancer, 10,273 persons with tumors of the brain and nervous system, 1,935 persons with thyroid cancer, 1,542 persons with bone tumors, and 2,318 persons with malignant neoplasms of the connective tissue. All cancer patients were diagnosed in Denmark between 1943 and 1980 and survived for 2 or more months. Nonmelanoma skin cancers were excluded from the analysis, whereas tumors of the brain and nervous system included both benign and malignant neoplasms. Overall, patients with these cancers showed no greater incidence of new tumors than expected from comparisons with the general population. An excess of chronic lymphocytic leukemia was observed subsequent to all cancers derived from the neural tube, i.e., melanoma and tumors of the eye, brain, and nervous system. Bone cancer occurred excessively, although the possibility of misclassified metastases could not be eliminated. Patients with tumors of the brain and nervous system who survived for 10 or more years developed significantly more cancers of the kidney and connective tissue and melanoma than anticipated. A deficit of second cancers of the digestive system was noted after primary bone and connective tissue cancers, in contrast to an excess of second cancers of the lung and kidney. Although based on few cases, patients with bone cancer showed a large excess of eye cancer as a second primary. The association between cancers of the breast and connective tissue was found to be bidirectional. Persons with connective tissue cancer were at increased risk of developing non-Hodgkin's lymphoma. Thyroid cancer patients were at high risk of subsequent tumors of the brain and nervous tissue and non-Hodgkin's lymphoma. However, contrary to previous reports, the risk of breast cancer was not elevated following thyroid cancer.
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PMID:Second cancer following cutaneous melanoma and cancers of the brain, thyroid, connective tissue, bone, and eye in Denmark, 1943-80. 408 10

Using an indirect immunoperoxidase technique, 20 nevocellular nevi, 5 dysplastic nevi, 14 primary cutaneous melanomas, and 24 metastatic melanomas were tested with a panel of monoclonal antibodies to monomorphic determinants of Class I (HLA-A,B,C) and Class II (la-like) major histocompatibility complex antigens. Class I HLA and beta 2-microglobulins were not detected on the majority of nevus cells but were expressed by 3 of 5 dysplastic nevi, by the majority of tumor cells in 12 of 14 primary cutaneous melanomas, and in 13 of 24 metastases. The different expression of Class I HLA and beta 2-microglobulins in primary and metastatic lesions suggests that loss of these antigens may be associated with progression of malignancy. Class II HLA were not detected in common nevi but were locally present in 1 of 5 dysplastic nevi, 7 of 14 cases of primary cutaneous melanoma, and all 24 cases of metastatic lesions tested. These findings suggest that increase in Class II HLA expression may be associated with progression of malignancy. The staining patterns obtained with monoclonal antibodies to distinct determinants of Class I HLA and Class II HLA were superimposable within each type of antigen. Therefore, the discrepancies in the literature about the expression of histocompatibility antigens by lesions of melanocytic origin are not likely to reflect the different specificity of the antibodies used by the various investigators.
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PMID:Immunohistochemical analysis of malignant melanomas and nevocellular nevi with monoclonal antibodies to distinct monomorphic determinants of HLA antigens. 620 49

The matter of sex differences in survival from melanoma is more complex than generally recognized, and at least 6 factors, some of which appear to be interrelated, must be conisdered: location of the primary melanoma; stage of disease at presentation; endocrine factors; immunologic factors; pattern of metastatic spread (i.e., lymphogenic versus hematogenic), and environmental and behavioral characteristics. Extremity melanomas have a more favorable prognosis than axial melanomas, but, after allowance for tumor site, women still fare better than men. There appears to be a stage-by-stage difference in favor of women for survival. This applies to clinical stages (stage 1, local disease; stage 2, regional spread; and stage 3, distant metastases), as well as to pathologic microstages. Some authors have inferred that female advantage disappears once the disease has metastasized. No valid explanation for this observation has ever been advanced, and careful review of the literature reveals a female superiority in survival at stage 2 or stage 3 disease as well as stage 1. Many recent studies have confirmed the ancient impression that the incidence of metastatic disease at the time of diagnosis is higher in men. Men tend to have an equal or shorter history before treatment, yet they have more advanced disease at the time of diagnosis. They have an unfavorable outcome irrespective of lesion site, tumor thickness, histogenetic subtype, and clinical stage of disease. These data suggest that the disease develops more rapidly in men. Thus, the aggressiveness and metastatic potential of cutaneous melanoma is more distinct in the male sex. The exacerbation of melanoma during pregnancy may be due to the increase of estrogens or to the elevated androgen levels. The first possibility is unlikely. The elevation of follicle stimulating hormone, luteinizing hormone, and MSH levels may play a role. Several case-controlled studies have failed to reveal any overall relationship between prior history of oral contraceptive use and the development of melanoma. Because the role of estrogens (and hormones in general) in the course of melanoma is not yet satisfactorily established, oral contraceptives are best avoided. It is concluded that malignant melanoma may be a hormone-responsive tumor, despite the fact that the exact nature of such endocrine factors remains nebulous.
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PMID:Sex differences in survival from cutaneous melanoma. 638 12

The results of treatment of 25 cases of malignant cutaneous melanoma of the floor of the auricle are presented. The involvement of the central area of the organ was matched by the least favorable clinical course. All patients of the latter group developed regional metastases. Therefore, a simultaneous removal of primary tumor and fascial-capsular excision of regional lymph nodes should be carried out unless the lymphatics are involved. The involvement of lymphatics makes the case for Crile's operation. In cases of peripheral position of melanoma, the approach to lymph node treatment should consider such factors as tumor invasion degree, growth pattern, histological type, patient's age and condition.
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PMID:[Melanoma of the skin of the concha auriculae]. 646

The presence of satellite and in-transit (SIT) metastases was investigated in 388 patients with cutaneous melanoma of the extremities, registered between 1956 and 1980. Out of 99 males 20 showed evidence of SIT lesions at the time of diagnosis or during follow-up, compared with 78 out of 289 females (P less than 0.05, allowed for clinical stage). The difference is even more striking if we consider that female patients had more favourable prognostic tumour characteristics than males.
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PMID:Female sex is a risk factor for satellite and in-transit recurrences from cutaneous melanoma. 654 Nov 36

All the 91 cases of enucleated malignant melanoma of the choroid and ciliary body in an area of the Swedish west coast (630 000 inhabitants) during the period 1956-1975 are analysed. The incidence was 0.72/100 000 inhabitants and year, which means that there was no increase lately corresponding to the increase described for cutaneous melanoma. Distribution according to age, sex and cell-type corresponded to other materials. 86 tumours were choroidal, 5 were located in the ciliary body. The mortality after 15 years was 50%. Tumours of the epitheloid type showed a surprisingly low mortality (29%). In only one case, with a 10 years survival, metastases were found at the time of primary diagnosis. The possibilities for early detection of metastases were, however, small. In 11 cases a period of delay and/or other treatment had preceded enucleation. The prognosis for these cases was not worse than for those who underwent immediate enucleation.
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PMID:Malignant melanoma of the choroid and the ciliary body 1956-1975 in Halland and Gothenburg. Incidence, histopathology and prognosis. 663 21


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