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 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Survival figures for patients with malignant melanoma in South Africa compare rather unfavourably with those from other countries, for example Queensland, Australia. The chief reason for this seems to be the late stage at which patients present with the tumour and hence the late diagnosis of melanoma in this country. A series of patients was studied and note was taken of their presenting symptoms and signs, which included growth of a pigmented lesion, bleeding, darkening, pain, tenderness and itching. Ulceration and satellitosis had developed in a small proportion of cases. Awareness of this tumour and education as to the circumstances in which it should be suspected should be encouraged, so as to ensure earlier diagnosis and treatment and thus higher survival rates.
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PMID:The presentation of malignant melanoma. 49 31

The clinical and histological features of 13 malignant melanomas in children less than 13 years of age in New South Wales, Australia, were compared with those in a control group of children with 15 Spitz nevi, 4 of which were considered atypical, and 2 unusual compound nevocellular nevi. Six of the controls had been previously diagnosed histologically as malignant melanoma. The objective observations made by one or more histopathologists experienced in reporting melanocytic lesions, and the clinical details, mainly from the Sydney Melanoma Unit files, were entered on a detailed protocol. Evaluation was assisted by the use of SPSS-X software on a mainframe VAX computer. Six of the 13 children with malignant melanoma died with their disease. The most frequent clinical features found in the malignant melanomas were bleeding, ulceration, itching, and black or variegated color. Recent enlargement and darkening were noted in the majority of both the malignant melanomas and the Spitz nevi. Histological features favoring malignancy in this series were mitoses within 0.25 mm of the dermal margin of the melanoma, a dermal mitotic rate exceeding 2/mm2, ulceration, surface exudate, large pigment granules, and clear-cell differentiation. The median thickness of the malignant melanomas was 1.3 mm but in the 4 children who died with melanoma the median thickness was 2.9 mm. Absence of mitoses, predominance of spindle cells, and diffuse maturation favored Spitz nevus. The median thickness of the Spitz nevi was 0.7 mm.
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PMID:Malignant melanoma in childhood: a clinicopathologic study of 13 cases and comparison with Spitz nevi. 156 97

The National Biotherapy Study Group (NBSG) conducted a broad phase II trial using interleukin-2 (IL-2) by continuous infusion and alpha interferon (IFN) subcutaneously in 267 patients with a variety of advanced cancers, including 29 with breast cancer, 89 with renal cancer, and 69 with melanoma. IL-2 [18 million international units (MIU)/m2] was given by continuous infusion for 108 hours with 3 mu/m2 subcutaneous IFN every other day during the IL-2 infusion. The patients were treated for 1 week followed by a 2-week rest. After two cycles of treatment, patients were evaluated for response. Of the 237 patients evaluable for response, 20 (8%) had a complete or partial response and 128 (54%) were stable. Therefore, 62% of the evaluable patients were nonprogressive during the first 90 days of IL-2/IFN therapy. The objective response rate was 11% in melanoma, 7% in renal cancer, 14% in breast cancer, and 3% in patients with a variety of malignancies for an overall response rate of 7% in these patients with advanced cancer. The patients were treated on a general medical ward and tolerated treatment well with fatigue and fever being nearly universal. Dyspnea, pruritus, chills, and elevated creatinines were frequent but less common. This combination biotherapy regimen has minimal activity in a variety of advanced cancers and must be compared with the best existing chemotherapy for each cancer type in randomized, prospective trials.
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PMID:Combination biotherapy utilizing interleukin-2 and alpha interferon in patients with advanced cancer: a National Biotherapy Study Group Trial. 162 72

Reducing morbidity and mortality from malignant melanoma is the greatest challenge facing dermatology today. We present a comparison of the Glasgow seven-point checklist and the American Cancer Society's ABCDs of pigmented lesions for detecting early melanomas. Logistic regression analysis showed that the Glasgow checklist (N = 205 lesions) contained two significant variables (irregular outline, P = .001, relative odds = 10.9; diameter greater than 1 cm, P = .005, relative odds = 6.7) for differentiating benign from malignant pigmented lesions whereas a three-point version of the ABCDs (N = 192 lesions) had three significant variables (irregular outline, P = .001, relative odds = 9.3; diameter greater than 6 mm, P = .008, relative odds = 5.5; variegation, P = .05, relative odds = 3.7). All six melanomas scored 3 out of 3 on the ABCD scale for a sensitivity of 1.00 and specificity of 0.98 at a threshold of 3 out of 3. Patients rarely sought dermatologic consultation because of these predictors but often sought help for nonsignificant reasons such as inflammation (P = .93), color change (P = .84), itch (P = .72), and increasing size (P = .38). The simpler three-point scale at a threshold of two had equal specificity (0.88 versus 0.94) and better sensitivity (0.73 versus 0.44) than the Glasgow seven-point checklist at the recommended threshold of three out of seven. We therefore recommend that the American public be better educated about the ABCDs to help increase self-referral so that early melanomas can be found and eradicated.
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PMID:Clinical predictors of malignant pigmented lesions. A comparison of the Glasgow seven-point checklist and the American Cancer Society's ABCDs of pigmented lesions. 174 May 63

A pigmented-lesion clinic was established in the skin department at King's College Hospital to coincide with the British public-education campaign on malignant melanoma. One-hundred cases of malignant melanoma have subsequently been seen and evaluated prospectively with regard to the usefulness of the Glasgow seven-point check-list as a guide to diagnosis. The most-frequently reported patient observations were growth of the lesion (74%) and change in its colour (53%) (especially darkening). However, 50% of the lesions were smaller in size than the 1 cm referred to in the check list and 15% were less than 0.5 cm. Itching was noted in 24% and bleeding and crusting were remarked upon in 18% of cases. Abnormal shape was noted in 20% of the patients. Inflammation was visible in only 11%. Seventy-three per cent of our patients had early lesions (less than 1.5 mm Breslow thickness) and nearly half presented at the insistence of their relatives or friends or because of the family doctor's incidental diagnosis. They stated they would not otherwise have attended the hospital and many had noticed nothing untoward even on direct questioning. Half of the patients scored less than three on the check list and 10 out of the 22 cases of nodular melanoma might not therefore have been referred to our clinic. The check list has subsequently been revised and now provides a more-sensitive guide.
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PMID:How do malignant melanomas present and does this correlate with the seven-point check-list? 179 86

The clinical and immune modulatory effects of interleukin-2 (IL-2) and interferon (INF) alfa-2a were examined in a phase II study in patients with metastatic renal cell carcinoma (six patients) and melanoma (eight patients). Treatment consisted in IL-2 3 MU/m2 continuous infusion days 1-4 and INF alfa-2a 6 MU/m2 subcutaneously day 1 and 4, both given on alternate weeks. Tumour response was assessed after four cycles of treatment or earlier, if necessary. Patients with stable disease or response were to be continued for another nine cycles or up to disease progression. The 14 patients received a total of 60 cycles of treatment. Major toxicities (WHO Grade III/IV) were fever, capillary leak syndrome with hypotension, nausea and vomiting, erythema with pruritus, leuco- and thrombopenia and sepsis with staphylococcus aureus. Five of 14 patients (36%) developed a self limiting autoimmune thyroiditis with HLA-DR expression on thyrocytes. Long term treatment toxicity was moderate with an average weight loss of 5% and an average fall in Karnofsky index of 10% compared to baseline. No responses were seen in renal cell carcinoma, two patients with melanoma had a partial and two a minor response with a duration of 1-7 months. Serial measurements of immune modulatory parameters showed a functional response to treatment with an increase of NK- and LAK-activity during the first two cycles, followed by a plateau and decrease during the third and fourth cycles. These findings were paralleled by a successive decline in treatment induced INF gamma response. These findings suggest, that alternative weekly treatment with IL-2 and INF alfa-2a results in an exhaustion of lytic capacity of NK- and LAK-cells and an attenuation of secondary cytokine release.
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PMID:Clinical and immune modulatory effects of alternative weekly interleukin-2 and interferon alfa-2a in patients with advanced renal cell carcinoma and melanoma. 199 8

In the absence of more effective treatment for advanced tumors, early diagnosis and treatment of localized tumors is the most effective way of reducing the burden of illness associated with melanoma. This study examined the following factors: prevalence of signs of melanoma (a mole changing in size, shape, appearance, or color, itching or tingling, bleeding or weeping, becoming raised) in 1344 individuals in a randomly selected sample of 1075 households; the length of delay in seeking medical advice; the factors associated with either going to a medical practitioner or not going/delaying; and the actions of the medical practitioners when first presented with these signs. The results indicate that a large proportion of the sample (11.9%, n = 156) had observed signs of melanoma in the previous 12 months. Of the sample reporting signs that had first appeared in the previous 5 years, only 32% sought medical advice about the signs within the recommended period. Of the sample either not seeking advice at all or delaying, 49% reported that they thought the sign "wasn't serious/would clear up." Furthermore, 30% of the sample either did not known or underrated the importance of early detection and treatment of lesions. These results indicate that there is a deficit in the knowledge of the general public about the signs of melanoma, the severity of the disease, and the possible risks associated with delay.
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PMID:A community study of delay in presenting with signs of melanoma to medical practitioners. 173 10

The incidence of cutaneous malignant melanoma is increasing by 10% a year and by as much as 30% a year among whites living in the sunbelt. If present trends continue, it will soon be one of the most common cancers occurring in fair-skinned individuals who have sustained severe sunburns. Although sunlight is the major cause of melanoma, several other factors, such as hormones, have also been implicated. Malignancy should be suspected in any pigmented lesion that changes in color or size, begins to itch, or bleeds or oozes spontaneously. Because of these characteristic and often highly visible changes, the disease can usually be diagnosed when surgically curable. Microstaging allows prognostic categorization of risk, with thickness the single most important prognostic factor for patients with disease clinically limited to the primary site. Staging also determines the treatment plan.
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PMID:The pathophysiology and staging of cutaneous malignant melanoma. 264 53

To record the potentially serious side-effects of melanoma and non-melanoma skin cancers and ocular damage following long-term PUVA chemotherapy, we re-examined 198 of 242 patients. These comprised: 90 with psoriasis, 27 with parapsoriasis, 19 with cutaneous T-cell lymphoma, 23 with vitiligo, eight with cutaneous mastocytosis, 16 with atopic dermatitis, three with prurigo nodularis, two with polymorphous light eruption and 10 with pruritus of chronic renal failure on dialysis, treated between 1977 and 1987 in our department. During the 10-year period, 11 patients died of unrelated disease. None of the patients reviewed had previous skin cancer or had been treated with arsenic, methotrexate or ionizing irradiation before PUVA treatment. None of the patients were children under 16 years of age. The mean age was 54.5 years, the sex ratio 102:96 (M:F). The mean cumulative dose of UVA for the whole group was 169.5 J/cm2. One patient with psoriasis, psoriatic arhropathy, ankylosing spondylitis and Crohn's disease, who was on azathioprine for 6 years, developed squamous-cell carcinoma on the left lower leg. Another patient with pustular psoriasis, who received PUVA treatment to her palms and soles only, developed malignant lentigo of Hutchinson on the right lower leg. PUVA lentigines were found in about 20% of patients. All patients had a yearly ophthalmological examination. None of them developed cataracts, lens opacities or had impairment of their visual acuity.
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PMID:Cutaneous and ocular side-effects of PUVA photochemotherapy--a 10-year follow-up study. 269 Nov 34

High-dose interleukin-2 (IL-2) with or without lymphokine-activated killer (LAK) cells has been reported to have activity in certain solid tumors, but toxicity has usually required hospitalization for administration. The purpose of this trial was to determine the antineoplastic effect and toxicity of IL-2 administered at a lower dose in an outpatient setting. Eligibility criteria included measurable disease, Karnofsky performance greater than or equal to 70%, age greater than 18 years, and adequate bone marrow, renal, and hepatic function. The median age of 35 patients was 56 years (range, 20 to 75). Diagnoses included malignant lymphoma (ML), (nine patients), chronic lymphocytic leukemia (CLL) (eight), melanoma (eight), colorectal cancer (six), renal cancer (two), and breast cancer (two). The initial 18 patients were treated with 1 mg/m2 (3 x 10(6) U/m2 intravenous [IV] bolus) for five days every other week for a total of 4 treatment weeks (8 weeks total). The subsequent 17 patients were treated with 0.5 mg/m2 (1.5 x 10(6) U/m2). All patients were evaluable for toxicity, and 26 for tumor response. Toxicities included fatigue (71%), nausea (69%), hypotension (54%), fever (51%), chills (40%), weight gain (37%), pruritus or rash (31%), dyspnea (14%), azotemia (6%), confusion (6%), thrombocytopenia (6%), and myocardial infarction (3%). Four patients died from apparently unrelated causes within the first 2 weeks of treatment. Treatment was discontinued before the completion of 8 weeks of treatment because of progressive disease (12 patients), severe hypotension (three), azotemia (one), myocardial infarction (one), early death (four), and miscellaneous causes (two). IL-2 at 1 mg/m2 IV for five days is associated with moderate toxicity, but a dose of 0.5 mg/m2 is tolerable for outpatient administration. Three partial responses (PR) and one minor response (MR) lasting 1 to 17+ months have been observed in 12 patients with ML and CLL evaluable for response. One additional MR was observed in a patient with melanoma. IL-2 deserves further study in patients with ML and CLL.
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PMID:Phase II trial of outpatient interleukin-2 in malignant lymphoma, chronic lymphocytic leukemia, and selected solid tumors. 278 39


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