MALIGNANT MELANOMA IN TURNER'S SYNDROME

A 45-year-old woman presented with a 2-week history of weakness with rapidly progressing abdominal distention. Two weeks previously she had an abdominal ultrasound that showed no evidence of ascites or malignant changes.
The patient was known to suffer from Turner's syn-drome 45XO/46XX and Hashimoto's thyroiditis for which she was treated with L-thyroxine. She also had numerous nevi, some of which were biopsied recently and interpreted as having no malignant features.
On admission, the patient complained of weakness and abdominal discomfort. She was of short stature and was pale. Her secondary sexual characteristics were fully devel-oped. Many pigmented nevi were scattered over her skin, without clinical signs of malignant transformation. Fundo-scopy showed no signs of malignancy in the choroid layer. The abdomen was tense and edematous. Breast examina-tion was normal. An ECG and chest x-rays were also within normal limits. Computerized tomography showed a large amount of fluid with small masses spreading in the peri-toneal cavity. Aspiration of the abdominal fluid revealed ma-lignant cells that stained positively with S-100, melanoma-specific antigens, and with Masson-Fontana (Fig. 1).     

MALIGNANT MELANOMA IN QUEENSLAND A REVIEW

A study into malignant melanoma in Queensland commenced in 1963 and the findings are reviewed and the attitudes to management explained. The incidence of the disease is higher in Queensland than anywhere else in the world. This probably results from the long continued exposure of a susceptible white population to sunlight. Patients with suspected melanomas should be referred for definitive surgical treatment without preliminary biopsy. Local surgical treatment usually necessitates a wide excision and split skin graft. Routine elective lymphadenectomy is not indicated. The outlook for patients with melanoma is remarkably good in Queensland. There is an age-adjusted cumulative five-year survival of 87.7% for women and 73.6% for men. The treatment of patients with advanced or recurrent melanomas should be carried out in special clinics.     

SUBCELLULAR TYROSINASE ACTIVITY IN FORTNER''S MALIGNANT MELANOMA

SUMMARY. —Biochemical and macromolecular characterizations of Fortner's melanotic melanoma of Syrian (golden) hamsters and of B-16 melanotic mouse melanoma were made using the Warburg manometric technique for estimation of the subcellular distribution of tyrosinase activity.
The results showed that the major amount of tyrosinase activity was located in the soluble fraction of Fortner's malignant melanoma. This differs from the B-16 melanoma in which the major activity was in the large granule fraction with virtual absence of activity in the soluble fraction.
Substantial increase in the tyrosinase activity of Fortner's melanoma fractions was observed after prolonged incubation. The biological significance of this delay in attaining V_max is discussed.     

CELL-MEDIATED IMMUNITY IN PATIENTS WITH MALIGNANT MELANOMA

Summary.— The activity of cell-mediated immunity to tumour-associated antigen has been studied in 12 patients with malignant melanoma, using the leucocyte migration inhibition test. Tests carried out in 10 of these patients before surgical removal of the melanoma showed significant migration inhibition in every case. In the immediate post-operative period this inhibition was lost, and return of significant inhibition was observed in 9 of the 10 cases tested pre-operatively and in the 2 cases for whom pre-operative tests were not available. Return of leucocyte migration inhibition was noted between the 4th and 22nd post-operative day. Possible mediators of this observed depression of cell-mediated immunity are discussed.     

PLANTAR MALIGNANT MELANOMA

A case of a 51 year old man with a plantar malignant melanoma is reported. The tumor had clinical and histologic features of lentigo maligna melanoma, but its biologic activity was that of a more potently malignant tumor. Electron microscopic observation reveales features similar to that of lentigo maligna melanoma, but not inconsistent with that of superficial spreading melanoma. A consideration of our case and of previous reports suggests that there is a relationship between the biologic potency and the site of involvement of lentigo maligna melanoma and that such lesions on relatively non-pigmented areas such as the palms, soles, mucous membranes, and nail beds should be treated as having a highly malignant potential.     

PLANTAR MALIGNANT MELANOMA

Among 51 cases of malignant melanoma seen at the Department of Dermatology, Tohoku University School of Medicine, from 1966 to 1978, 16 cases had had the primary lesion on the sole. The average age of these 16 cases was 63 and the sex ratio (M:F) was 11:5. The common sites of involvement on the sole were the heel (in 9 cases) and the toes and metatarsal region (in 5 cases). In 14 cases the lesions arose on the right sole; furthermore, 6 cases had had histories of trauma before or after the development of tumor and 7 cases had received insufficient excisions of their lesions, all of which showed a recurrence and/or lymph node metastasis within a year. These data suggest that traumatic stimulation may have some effect up on the pathogenesis of plantar melanoma. The clinicopathological features of plantar malignant melanoma in Japan are also described.     

DIAGNOSIS AND TREATMENT OF MALIGNANT MELANOMA IN BULGARIA

SUMMARY. The available diagnostic procedures for malignant melanoma are critically discussed. The hazards of simple excision biopsy can be reduced by the technique of radiation or chemotherapeutic cover.
Methods of treatment are reviewed and the 5 year follow-up results of the treatment of 136 patients in the author's clinic are reported.
It is concluded that both radiation and surgery have a place in the treatment of this tumour.     

EFFECTIVE DETECTION OF PLANTAR MALIGNANT MELANOMA

Background: As the sole of the foot is the most prevalent site of malignant melanoma in non-Caucasians, early detection of the neoplasm at this anatomical site is very important. In our previous study, we proposed a clinical guideline that acquired melanocytic lesions on the sole larger than 7 mm in maximum diameter should be examined histologically. Methods: Eighty-one Japanese patients with the complaint of plantar pigmented lesions were screened at our dermatology clinic during 3 years using the 7-mm criterion. Results: Of the total 80 melanocytic lesions on the sole, 14 lesions were larger than 7 mm in maximum diameter, excluding congenital lesions. Diagnoses of the 14 “large” lesions were as follows: advanced malignant melanoma, 8 lesions; early malignant melanoma (malignant melanoma in situ), 1 lesion; acquired melanocytic nevus, 4 lesions, and volar melanotic macule, 1 lesion. Conclusions: The present study confirmed the validity of the 7-mm criterion for the early effective detection of plantar malignant melanoma.     

SPONTANEOUS REGRESSION OF HUMAN MALIGNANT MELANOMA

Cellular and subcellular changes and cell-mediated immunity of a patient (a 26-year-old man) with spontaneously regressed malignant melanoma are described. The patient developed black nodules on his left leg and foot several times over a period of 11 years. These nodules necrotized, regressed to form crusted nodules and disappeared leaving white macules. Many melanin-laden cells (so-called melanophages) were seen in the upper dermis of the melanotic macules, and no melanoma cells were observed in the upper dermis of the white macules which appeared at the site of regressed melanotic macules or nodules. In melanin-laden cells observed in melanotic macules, many melanosome complexes with hydrolytic enzyme activity and a small number of single melanosomes were recognized. We assumed that some or many of the melanin-laden, melanophage-like cells in the upper dermis of a regressing malignant melanoma might be effete melanoma cells. Cell-mediated immunity had been preserved while spontaneous regression of tumors was occurring. However, the patient died as a result of metastatic melanomas which involved the lymph nodes, liver, bones, brain, heart, kidney, lung and gastrointestinal tract.     

INTRACELLULAR LOCALIZATION OF TYROSINASE INHIBITOR IN AMELANOTIC AND MELANOTIC MALIGNANT MELANOMA

Summary.— Intracellular distribution of the tyrosinase inhibitor in malignant melanoma cells has been investigated in order to elucidate the defect of melanization in the pigment cell cytoplasm and premelanosomes of amelanotic melanoma. We have found that the tyrosinase inhibitor has its highest activity in the cytoplasmic soluble fraction for both amelanotic and melanotic melanomata. However, inhibitor assay of melanoma subfractions reveals a distinct difference between the inhibitor activity of amelanotic and melanotic melanomata. Premelanosome-containing subfractions of amelanotic melanomata contain much higher inhibitor activity than those of melanotic malignant melanomata. A high concentration of inhibitor seen in subfraction 3 which contains most of the total succinoxidase activity is found to be contained in the premelanosomes of this subfraction.
It is suggested that the absence of melanization in the non-premelanosomal cytoplasm of pigment cells and in the premelanosomes of tyrosinase containing amelanotic melanomata is directly related to the concentration of tyrosinase inhibitor in these compartments of the cells.