Malignant melanoma: changing trends in factors influencing metastasis-free survival from 1964 to 1982

Article Abstract:

A retrospective analysis of 714 patients with stage I melanoma, a pigmented tumor, revealed changes in the characteristics of the disease which have occurred from 1964 to 1982. Three major prognostic indicators, tumor thickness, ulceration, and inflammatory cell infiltration, were all found to have decreased over time, probably because patients were more aware of skin changes and sought medical attention at an earlier stage. Melanomas were detected sooner due to better monitoring of changes in moles, particularly by male patients, suggesting that men are becoming more aware of skin blemishes. Unfortunately, two other factors which have prognostic value in cases of melanoma have shifted in the direction of poorer prognosis. There was an increase in the incidence of melanomas of the epithelioid cell type. This may result from changes in the pathogenesis of the cancer, but the cause is uncertain. There were no differences between the sexes in the changes in epithelioid cell frequency. Another prognostic factor which changed over the study period was the location of the primary tumor. Melanomas on the trunk of the body, which have a poorer prognosis, became more common. This trend occurred among female patients; the changes observed in men showed no clear pattern. The increase in melanoma occurring on the trunk is thought to be largely due to wearing less clothing and greater leisure time, both factors which contribute to increased sun exposure. Current estimates of the five-year metastasis-free survival of patients with melanoma range from 93 percent for the "good" cases with positive prognostic indicators to 34 percent for the "bad" cases. The trends observed in the characteristics of melanoma over the 18-year period appear to be due both to behavioral changes and to biological changes in the tumors themselves. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Prognosis, Demographic aspects, Skin cancer, Mole (Dermatology), Nevus

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Immunohistochemical study of melanocytic nevus and malignant melanoma with monoclonal antibodies against S-100 subunits

Article Abstract:

S-100 is a calcium-binding protein that is commonly found in the nervous system. Although originally thought to be found exclusively in the nervous system, S-100 has now been identified in a variety of other tissues and cells, including melanocytes (pigment-producing cells). The original observation of S-100 in melanocytic nevi (moles) and malignant melanoma was accomplished using polyclonal antisera. This antibody staining thus recognized the sum total of many antibody-reactive sites of the complete S-100 molecule. A more detailed study has now been conducted using monoclonal antibodies to the alpha and beta subunits of the S-100 molecule. Therefore, it is possible to observe variations in the expression of molecular subunits in individual cells, which is not possible with the all-encompassing polyclonal antibodies. The immunohistochemical staining showed little staining for either the alpha or beta chain of S-100 in ordinary junctional nevi. However, in the junctional nests of dysplastic, or abnormal, nevi, the alpha chain could be detected. The beta chain could not be detected in melanomas which were spreading superficially, but was present when the lesion had begun to invade the underlying tissue. Most melanomas stained for both the alpha and the beta chains. The results indicate that the expression of the alpha and beta chains in melanocytes and melanoma cells may be an indicator of tumor progression. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Calcium-binding proteins, Calcium binding proteins, Immunohistochemistry

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Excisional biopsy as the first therapeutic procedure versus wide excision of malignant melanoma

Article Abstract:

There is some disagreement about the most appropriate method of treating a lesion suspected of being malignant melanoma, a cancerous mole or tumor of the skin. Some favor biopsies with narrow margins done under local anesthetic, some small biopsies which cut into the suspected cancer itself, and others favor an immediate wide area excision under general anesthesia. To evaluate the efficacy of these procedures, records of 1,234 patients with malignant melanoma were compared. All patients had primary malignant melanoma with no sign of spread; 319 had excisional biopsy with narrow margins, while 280 had biopsies under general anesthesia followed immediately by wide excision when a histological diagnosis of melanoma was made. The experimental control subjects were 635 patients who had received primary wide excision of the suspect area. A comparison of the five-year survival rates showed no significant differences between the groups. These results and others in the literature suggest that the immediate wide excision of a suspected melanoma is not necessary, and that a delayed wide excision is a safe procedure. These results do not reflect on incisional biopsies which cut into the suspect lesion itself, which are, in general, probably unsafe for malignant melanoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Surgery, Excision (Surgery)

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