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Query: UMLS:C1522102 (Melanoma)
 7,698 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The frequency of melanoma (CMM), and of common and dysplastic naevi (CN and DN) in areas of skin chronically, intermittently and rarely exposed to UV light was investigated in 121 melanoma patients (30-50 years) and 310 controls. Both cases and controls had significantly more CN in intermittently exposed areas than in areas chronically or rarely exposed. The ratio of observed to expected number of CMM was also highest in intermittently exposed skin (1.3 compared to 0.8 in chronically exposed and 0.5 in rarely exposed areas). Thus, intermittent UV exposure seems to have the most potent 'naevogenic' as well as carcinogenic effect on melanocytes. Nineteen per cent of controls and 56% of cases had naevi fulfilling the clinical criteria for DN. The distribution pattern of DN was clearly different from that of CN and does not accord with the idea that UV light is a major aetiological factor for DN. The probability of CMM significantly increased with the degree of relative clustering of CN (p less than 0.05) and of DN (p less than 0.01). This co-variation of naevi and CMM over the body surface might be the result of the local insults to the melanocyte system caused by UV light and/or to the fact that naevi are precursor lesions of CMM.
Melanoma Res
PMID:Regional distribution of common and dysplastic naevi in relation to melanoma site and sun exposure. A case-control study. 142 92

From January 1988 to December 1989, 920 patients with pigmented cutaneous lesions, clinically diagnosed as suspected or certain cutaneous melanoma (CM), underwent excision under local anaesthesia as outpatients. Histological examination confirmed CM in 135 patients. Patients in this group whose initial excision was for biopsy purposes only (extending 1-2 mm beyond the lesion margin) underwent a subsequent radical excision (extending greater than or equal to 10 mm from the neoplastic margin). The second resection was carried out within 10 to 15 days of the first, on an outpatient basis if the thickness of the CM was less than or equal to 2 mm, and in hospital if it was greater than 2 mm. The clinical diagnosis proved correct in 88 cases (65%) where exeresis was the definitive surgical treatment. Outpatient surgery seems to be the best method for easing a workload dominated by the need to examine a growing number of pigmented skin lesions, without altering the prognosis for CM.
Melanoma Res
PMID:Outpatient surgical treatment of cutaneous melanoma. 142 94

This retrospective study examines the experience of the Sydney Melanoma Unit in the management of cervical lymph nodes among patients with cutaneous melanoma of the head and neck. From 1960 to 1990, 397 patients had neck dissections for cutaneous malignant melanoma of the head and neck. This number represents 40% of all patients treated for head and neck melanoma at the Sydney Melanoma Unit during this period. Neck dissections were therapeutic in 152 patients, elective in 234 patients and for an unknown indication in 11 patients. Lymph nodes were histologically positive in 39% of operations overall and in 7% of elective neck dissections. The incidence of recurrence in the neck after dissection was 24% overall, 28% when nodes were histologically positive and 13% when nodes were histologically negative. Patients who developed recurrent neck disease after neck dissection had a worse prognosis than those with positive nodes who did not recur, but the difference in survival was not statistically significant. Patients with histologically positive nodes had a significantly worse survival than those with negative nodes, 34% vs 67% respectively at 10 years (p less than 0.001). Elective neck dissection was associated with a significant improvement in survival for patients with melanomas 1.5-3.9 mm thick, using univariate analysis. This apparent benefit was lost when multivariate analysis was carried out. Patients having elective neck dissection currently have selective modified radical dissections depending upon the anatomic site of the primary melanoma. Postoperative radiotherapy is used for multiple positive nodes or extracapsular spread.
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PMID:Neck dissection for cutaneous malignant melanoma. 156 2

To increase detection of melanoma, medical practitioners and the general public should know the signs of early invasive melanoma. The Scottish Melanoma Group recently presented a revised checklist of the major and minor signs. The validity of the reported clinical and histopathologic criteria for the dysplastic nevus, a precursor to cutaneous melanoma, is not fully established. However, expert pathologists agreed on the use of major and minor criteria. The differential diagnosis between spindle-epitheloid cell nevi and melanoma remains problematic, because the former lesions often show cellular atypia. Other lesions that can cause considerable diagnostic difficulties are melanoma in situ and minimal-deviation melanoma. Immunohistochemical studies of human melanocytic lesions have contributed to the diagnosis of poorly differentiated tumors but, so far, have not helped in the discrimination among benign, premalignant, and malignant lesions. They have provided additional prognostic information in cases of primary melanoma and locoregional melanoma metastasis. Quality control of antibody reagents continues to be a problem. Microstaging of primary melanoma using Breslow depth and Clark's level of invasion may be subject to considerable intra- and interobserver variation. To improve the accuracy of the measurements, using a vernier scale is recommended. The type of melanoma is relevant in considering clinicopathologic prognostic factors. Acral melanoma (for example, that arise from glabrous skin) has been reported to carry a grave prognosis. Polypoid melanoma may have a less unfavorable outlook than previously thought. DNA cytophotometry provides prognostic information in case of primary melanoma but loses significance when stratified for tumor thickness. In patients with lymph node-positive melanoma, however, DNA ploidy analysis appears to yield additional prognostic information. In the management of primary disease, the width of the surgical excision and whether to approach the regional lymph nodes remain the main issues. A multicenter study conducted by the World Health Organization Melanoma Programme has found that a "narrow" excision is a safe procedure for primary melanomas not thicker than 1 mm. Several investigators underline the need for continued annual follow-up for all melanoma patients; recurrence may occur late. Currently, elective lymph node dissection is not recommended in the management of "thick" primary melanoma. Because data from randomized trials conducted in patients with a tumor of intermediate thickness are not yet available, only guidelines on management offered by experienced surgeons can be given. Patients with the dysplastic nevus syndrome should be closely followed so that melanomas can be diagnosed as early as possible.
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PMID:Clinical and pathologic diagnosis, staging and prognostic factors of melanoma and management of primary disease. 159 9

Skin types 1 and 2, increased numbers of moles, and excessive intermittent sun exposure are known risk factors for cutaneous melanoma, but the inter-relationship between UV radiation exposure, moles and melanoma remains unclear. There is a noteworthy site variation in melanoma, it being more common on the lower leg in women and on the back in men. In order to determine whether this site variation could provide further clues to the pathogenesis of melanoma, we examined site variation in photosensitivity and its relationship to other known melanoma risk factors (number of moles, skin type and skin colour) in 25 healthy volunteers. A marked site variation in photosensitivity was found. The pale skin of the volar aspect of the forearm was markedly less photosensitive than the darker skin of the back. Females were more photoresistant than males on the lower legs even though this is the more common site for melanoma in women. There was some correlation between the number of moles and photosensitivity at the two sites.
Melanoma Res 1992 Jul
PMID:Risk factors for melanoma: site variation in minimal erythema dose. 164 34

Between 1960 and 1990, a total of 998 patients were treated at the Sydney Melanoma Unit for cutaneous melanoma of the head and neck. There were 595 male and 403 female patients, with a median age of 53 years. The most common primary lesion site was the face (47%), followed by the neck (29%), scalp (14%), and ear (10%). Histologic types were as follows: superficial spreading 30%, nodular melanoma 28%, lentigo maligna melanoma 16%, and other 26%. All patients underwent surgical treatment. Primary closure of wounds was achieved in 52% of patients, and excision margins were 2 cm or less in 45%. A total of 152 patients had therapeutic neck dissections, and 234 had elective neck dissections. The overall local recurrence rate was 13%, and this was significantly influenced by increasing tumor thickness and Clark level. The recurrence rate in the neck after neck dissection was 24%, and the rate of parotid recurrences was 14%. Melanoma-specific survival was 77% at 5 years and 66% at 10 years for the entire group. By univariate analysis, survival varied significantly with age, tumor thickness, ulceration, anatomic sub-site, histologically positive nodes, and the presence of distant metastases. A diagnosis of lentigo maligna melanoma and elective lymph node dissection both appeared to improve survival. With multivariate analysis, all of these factors remained significant prognostic factors except elective node dissection, which lost its beneficial influence.
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PMID:Experience with 998 cutaneous melanomas of the head and neck over 30 years. 195 80

To determine the prognostic relevance of the anatomic site of origin of cutaneous melanoma to survival, we retrospectively analyzed a computerized database of 3428 patients with stage I and II cutaneous melanoma. Patients were stratified by the recognized prognostic variables of stage of disease, Clark's level of invasion of the primary lesion, and the nodal involvement at the time of lymphadenectomy. Melanoma arising in skin of the upper part of the back, back of the arms, neck, and scalp (BANS) region occurred more frequently in male than female patients. There were no statistically significant differences in the distribution of Clark's level of invasion of BANS and non-BANS region primary melanomas or in the extent of nodal involvement in patients with stage II disease. The 5-year actuarial survival of patients with stage I BANS region melanomas was 87%; stage I non-BANS, 89%; stage II BANS, 38%; and stage II non-BANS, 69%. The BANS region appears to have prognostic significance in cutaneous melanoma and, particularly, in patients with stage II melanoma.
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PMID:The importance of anatomic site in prognosis in patients with cutaneous melanoma. 200 64

Melanoma is increasing in incidence. An often-unsuspected complication is metastasis to the gastrointestinal tract, which leads to bowel obstruction or intussusception. The most common symptoms in patients with gastrointestinal metastasis are vomiting, abdominal pain and abdominal distention. Metastatic disease should be suspected in any patient with gastrointestinal symptoms and a history of cutaneous melanoma.
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PMID:Melanoma metastatic to the gastrointestinal tract. 240 21

A population-based case-control study was conducted in Denmark to assess the association between cutaneous malignant melanoma and various reproductive and hormonal variables. Previous studies have found a putative association of cutaneous melanoma and the use of oral contraceptives (OCs) and menopausal replacement estrogens. This study of 280 cases and 536 controls evaluated the influence of potentially confounding variables on cutaneous melanoma risk by stratified contingency table analysis. No association was found between risk of melanoma and age at menarche, duration of menstrual life, age at natural menopause, duration of menstrual life, age at natural menopause, age at 1st pregnancy, number of pregnancies, and live births or miscarriages. Surgical menopause slightly decreased the risk of melanoma, but this risk reduction was not significant. 40% of the case and 44% of the controls reported ever-use of OCs. Melanoma risk was unrelated to the duration of OC use, recency of use, age at 1st use, age at latest use, or type of OC formulation. Restriction of the analysis only to high-estrogen or low-estrogen OCs did not affect the risk estimates. Similarly, menopausal replacement therapy was not associated with melanoma risk, even when duration of use of type of hormone replacement therapy (unopposed estrogens, opposed estrogens, or progestogens) were examined. Finally, analysis by histologic subtype gave no indications of an association between either superficial spreading melanoma or nodular melanoma and any of the endogenous or exogenous hormonal variables.
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PMID:The Danish case-control study of cutaneous malignant melanoma. III. Hormonal and reproductive factors in women. 319 24

Cutaneous malignant melanoma often metastasizes to the lung, bone, liver, subcutaneous tissue, and lymph nodes. Six cases of malignant melanoma metastatic to the orbit are presented, five from cutaneous melanomas and one from a contralateral choroidal melanoma. Melanoma rarely metastasizes to the orbit, but when orbital involvement occurs, widespread metastases are already present. Twenty-two cases were reviewed from the literature; 13 of 14 patients, with sufficient follow-up data, had widespread metastases when they presented with orbital disease. Extraocular muscles appear to be a favored site of metastases. The mean time from orbital presentation to death was 4 months. Orbital metastases from a distant melanoma is, therefore, part of a widespread metastatic process. Treatment should be directed toward palliation.
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PMID:Melanoma metastatic to the orbit. 323 41


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