Melanoma case survival rates in South Australia by histological type, thickness and level of tumour at diagnosis

Data from the South Australian Cancer Registry on malignant melanoma of the skin showed that case survival rates were higher for lentigo maligna melanomas and superficial spreading lesions than for nodular and other histological classifications. Lower case survival rates applied to the thicker melanomas and those at a more invasive level at diagnosis. After adjusting for differences in thickness and level in this study, no statistically significant differences were apparent between case survival rates for the nodular lesions and the lentigo maligna and superficial spreading melanomas.     

Risk factors for cutaneous melanoma. A practical method of recognizing predisposed individuals

Cutaneous melanoma is rapidly becoming a potentially curable cancer if it is detected and properly treated in an early phase of development. Unlike other cancers, which are usually hidden from detection until they are relatively large or metastatic disease has occurred, cutaneous melanoma is readily detectable simply by examining the skin. Information is now available that will be useful in selecting individuals at greatest risk. The most important melanoma risk factors (in decreasing order of importance) for a given individual are as follows: a persistently changed or changing mole, adulthood, irregular varieties of pigmented lesions (including dysplastic moles and lentigo maligna), a congenital mole, Caucasian race, a previous cutaneous melanoma, a family history of cutaneous melanoma, immunosuppression, sun sensitivity, and excessive sun exposure. Selective screening and appropriate treatment of individuals who have these risk factors may reduce the morbidity and mortality of cutaneous melanoma.     

Melanoma in primary care. The role of the general practitioner

Background

The British Association of Dermatologists and the National Cancer Control Programme in Ireland discourage all GPs from biopsying any lesions suspicious of melanoma.

Aim

The aim of this study was to assess whether or not it is safe and practical for a general practitioner with extra training in dermatology and skin surgery to assess suspicious skin lesions and treat low risk melanomas.

Method

The outcome of 56 new melanomas (31 invasive, 7 in situ and 18 lentigo maligna) in 53 patients, managed by a GP with extra training in dermatology and skin surgery, over a 20 year period, was examined.

Results

Forty-eight (86 %) of the melanomas had the initial biopsy carried out in primary care. The average time from presentation to the practice to the date of the biopsy was 8 days for the in situ and invasive melanomas and 17 days for the lentigo malignas. Twenty-eight (50 %) of the melanomas were considered low risk (in situ, invasive <1 mm deep or lentigo maligna) and were treated successfully in primary care according to the Australian and New Zealand guidelines, without any surgical complications.

Conclusion

GPs with extra training in skin cancer and skin surgery could assess most suspicious skin lesions with dermoscopy and if necessary, biopsy most of these lesions in primary care. This would lead to a quicker diagnosis, more rapid pathway to definitive treatment, lower cost and more convenience to the patient, especially for those living in rural areas.     

Pigmentation and skin reaction to sun as risk factors for cutaneous melanoma: Western Canada Melanoma Study

Between 1 April 1979 and 31 March 1981, 904 residents of the four western provinces of Canada (population 6.5 million), were diagnosed as suffering from primary cutaneous malignant melanoma. Of 801 patients aged 20-79 years, 665 (83%) were interviewed along with control subjects chosen at random from the general population and matched for age, sex, and province. After exclusion of 70 subjects with lentigo maligna or acral lentiginous melanoma, comparisons of the 595 case-control pairs showed that light hair, skin, and eye colour, a history of heavy freckling in adolescence, and a tendency to burn readily and tan poorly in the sun were significant risk factors for melanoma. The strongest primary associations were with blond hair (relative risk 7.1 compared with black hair), light colour of unexposed skin (relative risk 2.4), and severe freckling (relative risk 2.1). These associations were independent of ethnic origin and of recorded amount of exposure to the sun and were somewhat stronger for superficial spreading than for nodular melanoma. This study is the largest and most detailed of an incident series of melanomas to be published to date. The results were consistent with other studies reporting associations between melanoma and poor tanning ability, a tendency to burn easily, and a history of sunburn and showed that light hair colour was the strongest risk factor for the disease.     

恶性黑素瘤研究进展

恶性黑素瘤发病率存在明显的人种、性别、地域和种族差异,发病因素多样、复杂且不确定,根据临床表现和病理组织学,主要分为浅表扩散型、结节型、恶性雀斑痣样和肢端雀斑痣样四型;确诊主要是靠病理诊断;目前常用的治疗方法是综合治疗,但效果不是很理想,其预后较差、病死率高。现从流行趋势、病因、临床表现与分型、临床诊断和治疗五方面对其进行总结。     

A clinicopathological correlation of 134 stage 1 and 79 non-invasive cutaneous melanomas presenting over a decade (1984–1993) at the Mater Misericordiae Hospital, Dublin

In a study of malignant melanoma during the period 1984–1993, 134 (63 per cent) had invasive melanoma and in 79 (37 per cent) melanoma was confined to the epidermis (in situ). There was female predominance, F: M = 2.4 1, a family history of melanoma in 1.5 per cent, a mean age at diagnosis of 50 yr. Females presented a decade earlier than males on average. Over half of invasive melanomas in females occurred on lower limbs; 40 per cent of lesions in males occurred on the trunk. Almost one third of lesions in males and over two thirds in females occurred in sun exposed area. Sixty per cent of invasive lesions were of the superficial spreading type and half of all lesions were histologically thin [less than 1.5 mm vertical depth]. Surprisingly, median lesion thickness was lower in males, probably reflecting the greater frequency of nodular lesions in females compared to males (36 per cent -v- 24 per cent). The marked increase in the number of invasive melanoma patients presenting in the second half of the decade studied (treble that of the first half) probably reflects an increase in melanoma incidence. Over the decade no change in invasive melanoma type, anatomical site or histological thickness was noted, the latter suggesting a failure to diagnose melanoma at an increasingly earlier stage. An official melanoma public education programme is required, particularly as half of the patients delayed 1 yr or more before seeking medical advice. However it is encouraging that, of the invasive melanomas, 30 per cent were small (<10mm), 50 per cent were histologically thin and that 37 per cent of all melanomas were in situ. The melanoma-in-situ group had a similar gender ratio and mean age at diagnosis to the invasive melanoma patients but lesions were smaller, were predominantly on the head, neck and limbs with lentigo melanoma as the commonest type.     

Treatment of Malignant Melanoma—A Review of 111 Cases

In a study of 110 patients with 111 malignant melanomas, the most important factors in determining the ultimate prognosis were: the sex of the patient, the site of the lesion and the clinical stage of the melanoma at the time initial treatment was carried out. When there was no spread beyond the primary area, the five-year survival rate was 64%. Excisional biopsy is preferable even though the dangers of incisional biopsy may have been overestimated in the past. The value of prophylactic lymph node dissection has not yet been unequivocally proved. The rationale for isolated perfusion therapy in the treatment of malignant melanoma is sound; nevertheless, the effect of this adjunct on survival and cure must await future critical analysis.     

Novel Approaches for Diagnosing Melanoma Skin Lesions Through Supervised and Deep Learning Algorithms

Dermoscopy is a technique used to capture the images of skin, and these images are useful to analyze the different types of skin diseases. Malignant melanoma is a kind of skin cancer whose severity even leads to death. Earlier detection of melanoma prevents death and the clinicians can treat the patients to increase the chances of survival. Only few machine learning algorithms are developed to detect the melanoma using its features. This paper proposes a Computer Aided Diagnosis (CAD) system which equips efficient algorithms to classify and predict the melanoma. Enhancement of the images are done using Contrast Limited Adaptive Histogram Equalization technique (CLAHE) and median filter. A new segmentation algorithm called Normalized Otsu’s Segmentation (NOS) is implemented to segment the affected skin lesion from the normal skin, which overcomes the problem of variable illumination. Fifteen features are derived and extracted from the segmented images are fed into the proposed classification techniques like Deep Learning based Neural Networks and Hybrid Adaboost-Support Vector Machine (SVM) algorithms. The proposed system is tested and validated with nearly 992 images (malignant & benign lesions) and it provides a high classification accuracy of 93 %. The proposed CAD system can assist the dermatologists to confirm the decision of the diagnosis and to avoid excisional biopsies.     

Intraoral malignant melanoma

Primary oral mucosal melanoma is a rare aggressive neoplasm and accounts for only 0.2-8% of all reported melanomas. It is a malignant neoplasm of melanocytes that may arise from a benign melanocytic lesion or de novo from melanocytes within normal skin or mucosa. It is considered to be the most deadly and biologically unpredictable of all human neoplasms, having the worst prognosis. In this article, we report a case of oral melanoma in a 52-year-old female patient with a chief complaint of black discolouration of the maxillary gingiva and palate.     

Satellite implantation of the skin with malignant melanoma

We report a 68-year-old female patient referred to the Surgical Department of Erbil Teaching Hospital university hospital, Erbil, Iraq with the diagnosis of malignant melanoma of the right upper thigh of one-year duration. Six months after primary lesion, she developed a satellite skin nodule of malignant melanoma over the unhealthy skin of the anterior abdominal wall in direct contact with the primary lesion. She also had a pendulous abdominal wall. This kind of spread of melanoma is unusual, and of non-classical route. We also discussed herein, similar cases admitted to our hospital.     

Familial malignant melanoma

Characteristics associated with familial compared with nonfamilial malignant melanoma were assessed. These data were obtained from consecutive prospectively completed questionnaires on 1169 cases of cutaneous malignant melanoma. Of these, 69 patients indicated a positive family history for this cancer. Among the various clinical and histological variables compared, those that significantly correlated with the familial occurrence of malignant melanoma include younger age at first diagnosis, smaller diameter of the lesion, lower Clark level, decreased frequency of nonmelanoma skin cancer, and reduced prevalence of noncutaneous cancer. Increased awareness of malignant melanoma among family members could account for some of these observations. Identification of the familial variety of malignant melanoma has practical implications concerning early detection and prompt intervention.     

Reasons for poor prognosis in British patients with cutaneous malignant melanoma

One hundred and twenty five patients presenting in the west of Scotland with primary cutaneous malignant melanoma answered a detailed questionnaire to establish whether there was any evidence of inappropriate delay in receiving surgical treatment for a new or changing pigmented lesion. The survey was carried out because of the relatively high proportion of patients in Scotland with melanoma presenting with primary lesions categorised as "thick, poor prognosis" and the poor five year survival figures as compared with many other countries. Of the 125 patients questioned, only 20 (16%) had received appropriate surgical treatment within three months of becoming aware of a suspicious cutaneous pigmented lesion; 63 (50%) had received surgical treatment three to 12 months after first noticing such a change, and in 42 cases (34%) this interval was over one year. In 102 of 105 patients in whom the interval exceeded three months the patient alone was responsible for the delay; in only three cases was the family doctor partially at fault. No evidence of delay by the hospital service was identified. Because of these findings a public education campaign was launched in the west of Scotland in June 1985 with the aim of improving recognition of early malignant melanoma. In the next six months the proportion of patients in the west of Scotland with primary melanomas categorised as "thin, good prognosis" had risen from 38% to 62%, and the proportion with tumours categorised as "thick, poor prognosis" had fallen from 34% to 15%.     

肢体皮肤恶性黑色素瘤手术治疗的疗效评价

目的：研究肢体皮肤恶性黑色素瘤手术治疗中预防性淋巴结清扫对患者生存率的影响。方法：对山西省肿瘤医院1998年至2008年收治的49例肢体皮肤恶性黑色素瘤，从中随机选取26例无转移患者分成两组手术。第一组为原发灶广泛切除加预防性淋巴结清扫9例；第二组为原发灶广泛切除17例。结果：两组治疗效果比较，两组之间1年、2年、3年复发率及死亡率均有差异，有统计学意义（P〈0．001）。结论：预防性淋巴清扫可降低肢体皮肤恶性黑色素瘤患者术后远处转移的发生率，且可提高生存率。     

Brain metastases of malignant melanoma in Chinese: report of 23 cases

Background Patients with melanoma metastasized to the central nervous system have a poor prognosis. Because the incidence of malignant melanoma in the Oriental is lower than that in the Caucasian population, brain metastases of malignant melanoma are rarely reported in Asia. Here we present our experience of brain metastasis of melanoma in an Asian perspective. Methods From 1990 to 2003, 369 patients with melanoma were treated in our hospital, 26 of them were diagnosed as having central nervous system involvement. Of the 26 cases, the clinical history, image, and pathologic findings of 23 patients were analyzed; the other 3 were excluded because of incomplete clinical data. Results Among the 369 patients with melanoma, 45% （167/369） developed lower extremity melanoma, and 27.1% （100/369） had acral lentiginous melanoma （ALM）; while in the 23 patients with brain metastases, 34.7% （8/23） had lower extremity melanoma, and 34.7% （8/23） had ALM. Among the 23 patients, 17 had acute hemorrhage into the tumor, 8 initially presented with a single cerebral metastatic lesion, and 15 had multiple brain lesions. Ten of them received surgery, 3 underwent stereotactic radiosurgery, and 16 received whole brain radiation. During follow-up, only 2 patients survived for more than 1 year, the median survival period was 5 months. The longest follow-up period was 11 years. Conclusions Compared with the Caucasian, Chinese patients with melanoma have a different proportion of melanoma subtype and higher incidence rates of lower extremities melanoma and ALM. However, their clinical presentation and prognosis are similar. The patients, who have excisable single or multiple brain lesions or limited extracranial disease and who are activelv treated, mav survive Ionoer.     

肢端恶性黑素瘤局部切除疗效观察

目的 观察21例肢端恶性黑素瘤(acral malignant melanoma,AMM)局部切除后疗效.方法 7例切除后直接缝合;13例较大损害,切除后植皮,切除范围距病灶0.5～3 cm;1例甲周损害截趾.结果 病理肢端原位黑素瘤8例全部存活;侵袭性黑素瘤13例,存活11例,死亡2例,5～11年存活率84.6%.结论 肢端恶性黑素瘤(AMM)依据损害形态,初步确定是原位或侵袭性,再确定切除范围,侵袭性恶性黑素瘤(MM)术后5～11年存活率为84.6%;原位恶性黑素瘤术后存活率100%.     

Primary malignant melanoma of the tongue

The oral cavity is a rare location for the development of primary malignant melanoma. The most common primary lesion sites are the palate and gingiva. Melanoma of the tongue is specifically uncommon. A 66-year-old woman was referred to our clinic with a complaint of a huge, painless, black, discolored mass on the right side of the oral tongue for 7 years. There were no cutaneous lesions suggestive of malignant melanoma over the rest of her body. The biopsy of the tongue lesion revealed a histopathology consistent with primary malignant melanoma. Computed tomography of the neck showed no significant cervical lymphadenopathy. Chest radiograph, whole body bone scanning, and abdominal sonography revealed no definite distal metastatic lesions. She received composite resection of the tumor on the right side of the tongue and right functional neck dissection. The patient had an uneventful recovery and received regular follow-up examinations. She was free of disease for more than 2 years. The treatment principle for primary tongue melanoma is wide surgical excision. Early diagnosis will be promoted by careful oral examination and early biopsy of pigmented and non-pigmented masses. We reviewed the published reports in the English literature since 1970 and fewer than 30 cases of primary tongue melanoma were presented. We present a case report and a review of the relevant literature.     

警惕色素痣——黑素瘤的危险信号

2010年7月29日出版的《临床医师肿瘤杂志》（CA Cancer J Clin）杂志刊载了一篇关于黑素瘤的研究综述．题为“黑素瘤诊断方法的革新：ABCDs诊断法确立后的25年”。我们对该论文进行研读后,就文中恶性黑素瘤的发生与色素痣密切相关,部分皮肤恶性肿瘤起源于色素痣,先天性痣可以转化为黑素瘤,色素痣的恶变是黑素瘤发生的一个重要因素。因此．我们应该重视黑素瘤和色素痣之间的关系,在临床工作中做到早发现、早诊断,以便及时的治疗等方面提出自己的见解,得到编辑的认可。我们撰写的Letter于2010年8月30日发表在《CA Cancer J Clin》杂志上。     

Pattern of malignancy in clinically solitary thyroid nodule

Solitary thyroid nodule (STN) is a common thyroid disorder. Clinically recognized thyroid carcinoma constitutes less than 1% of human malignant tumours. The risk of malignancy in solitary thyroid nodule is greater than other thyroid swelling. The risk of malignancy in generalized thyroid swelling is about 3% and in solitary thyroid nodule it is about 15%. This study was carried out in Surgery and ENT Department, Mymensingh Medical college Hospital from November 2008 to October 2009 to see pattern of malignancy in clinically solitary thyroid nodule. Total 108 patients of STN was included in this study, majority of the patients were within 20-39 years age group with female predominance. In addition to thyroid swelling some patients presented with other symptoms like cervical lymphadenopathy in 6(5.56%), dysphagia 2(1.85%), hoarseness of voice 2(1.85%) and metastatic lesion in bone 1(0.92%) cases. Among 108 cases of solitary thyroid nodule only 19 cases were malignant. Patients with malignant lesion presented with shorter duration of symptoms. Out of 19 malignant cases 6(31.58%) cases presented with features of metastasis. Malignancy was more predominant in male (25.00%) than the female (14.47%) in STN. Out of 19 malignant cases, 12(63.16%) were papillary carcinoma, 5(26.31%) were follicular carcinoma and 2(10.53%) cases were medullary carcinoma. Study showed significant difference (p<0.01) between papillary & follicular carcinoma and significant difference (p<0.001) between papillary & medullary carcinoma. Papillary carcinoma was most common among all thyroid malignancies in patients with solitary thyroid nodule.     

Identifying people at high risk of cutaneous malignant melanoma: results from a case-control study in Western Australia

To assess whether screening people at high risk of malignant melanoma would be effective in reducing the mortality from the disease data from 400 case-control pairs in a study of cutaneous malignant melanoma conducted in Western Australia during 1980-1 were used to predict the risk of melanoma in the remaining 111 pairs. All variables previously shown to be associated with a decrease or increase in the incidence of melanoma were considered for inclusion in a single conditional logistic regression model of the incidence of melanoma in the randomly chosen subset of 400 case-control pairs. Five of these variables--number of raised naevi on the arms, arrival in Australia before 10 years of age, history of non-melanocytic skin cancer, time spent outdoors in summer from the age of 10 to 24, and family history of melanoma--provided good discrimination between patients and controls in this sample and the 111 other case-control pairs. Among the 222 subjects in these other case-control pairs a group defined as being at high risk of melanoma by a risk score derived from these five variables contained 60 (54%) of the patients with melanoma but only 18 (16%) of the controls. These data suggest that in Western Australia more than half of all new patients with melanoma arise in an identifiable subpopulation constituting less than one fifth of the whole population. Identifying this subpopulation and screening it regularly for cutaneous malignant melanoma could be cost effective in reducing mortality from this disease.     

Subungual amelanotic melanoma: a diagnostic pitfall

A 35 year old female presented with a persistent amelanotic lesion of the nail bed of the left great toe for 1 year, associated with destruction of the overlying nail. Incision biopsy revealed a nodular malignant melanoma and the toe was amputated. There is no sign of recurrence at 18 month follow-up. As prognosis is related to local disease extent, any persistent nail bed lesion should be biopsied to exclude the possibility of malignant melanoma.