Diagnosis of malignant melanoma by general practitioners and hospital specialists

The aim of this study was to audit all malignant melanomas confirmed histologically in the Scarborough Health District over six years, prompted by the continuing rise in incidence rate nationally and relatively high number of malignant melanomas excised by general practitioners (GPs) in this area. A total of 157 malignant melanomas were diagnosed (60% from females and 40% from males) over the six years; primary excisions being carried out by GPs (37%) and hospital specialists (63%). The clinical diagnosis of malignant melanoma was made in 9% of GP cases and 35% of the hospital specialist cases. However another 45.5% of GP cases, and 38% of hospital specialist cases were regarded as suspicious pigmented lesions clinically. The histological diagnosis was of superficial spreading malignant melanoma in 72% of the GP and 69% of the hospital specialist cases. Most of the GP melanomas were excised with a lateral margin of 2 mm or less (71%); around half of the hospital excisions had a margin of over 2 mm (49%). Most melanomas were 2 mm or less in depth (Breslow depth) in both the GP (81%) and hospital specialist (75%) series. Over the six year period (1993-98) the incidence of malignant melanomas has continued to rise, but Breslow depth at diagnosis has not changed significantly. It is therefore important to continue with early recognition of this condition by GPs in the first instance, reduction in its incidence being the long term goal. During five years of the study there were only 67 lesions thought clinically to be malignant melanoma (26 GP and 41 hospital specialist cases), but which proved to be benign histologically.     

Malignant melanoma over a fifty-year period: a histological evaluation

The incidence of primary cutaneous malignant melanoma is increasing in the developed countries. Cutaneous malignant melanomas diagnosed in our Department over a period of fifty years from 1930 to 1980 were examined to see if there was any change in their histological features. In 1930 and 1955, over 90% of malignant melanomas presented as tumours infiltrating deep into the subepithelial tissue. By 1980, 55% of tumours presented with deeply infiltrating lesions and only 20% occurred at a stage where adequate local excision could provide hope of a cure. There is thus a need for greater awareness among the medical profession and the public if we hope to be able to treat malignant melanomas at an early stage.     

Factors related to the presentation of patients with thick primary melanomas

OBJECTIVE: To identify any characteristics of patients that are associated with presentation with thick primary melanoma. DESIGN: This was a retrospective survey of the clinical records of 1300 patients attending the Newcastle Melanoma Unit. Characteristics of 131 patients with thick melanomas (defined as 3 mm or greater in thickness) were compared with those of 543 patients with thin melanomas (defined as 0.75 mm or less in thickness). Comparisons were made using contingency table analysis, Wilcoxon rank sum tests, log rank analysis and logistic regression. SETTING: The Newcastle Melanoma Unit is a tertiary referral centre for the treatment of primary melanoma. PATIENTS: We surveyed all 1300 patients attending the Newcastle Melanoma Unit over the years 1981-1990. They represented approximately 90% of the patients in the Hunter region of New South Wales who developed melanoma during this period. Excluded from analysis were 39 patients with occult primary melanomas, 79 with multiple primary melanomas, 51 with primary melanomas of unknown thickness and seven with incomplete records, leaving 1124 patients in the study. MAIN OUTCOME MEASURES: These were selected before the results were known. The hypothesis was generated following analysis of the data. RESULTS: Patients with thick primary melanoma were more likely to be men (68% men and 32% women in the thick melanoma group, compared with 45% and 55% respectively in the thin melanoma group, P less than 0.005) over 60 (75% were over 50 years of age in the thick group versus 33% in the thin melanoma group, P less than 0.001) with nodular melanoma (62%, versus 2% in the thin melanoma group, P less than 0.001) and with melanoma on the head and neck (27%, versus 12% in patients with thin melanoma, P less than 0.005). The time from detection of a change in skin to diagnosis was not longer for those with thick compared to those with thin melanomas. CONCLUSION: The greatest problem of those with thin melanomas. CONCLUSION: The greatest problem of detecting melanoma at an early (surgically curable) stage appears to be in patients over the age of 50 who have nodular melanoma, particularly in the head and neck.     

The dysplastic naevus syndrome in patients with cutaneous malignant melanoma in Western Australia

One hundred and three patients with cutaneous malignant melanoma responded to an invitation to attend a dermatology outpatient clinic. All patients with a family history of melanoma, a history of multiple melanomas, or histological evidence of a dysplastic naevus that was associated with their melanoma were invited. A random sample of other patients with cutaneous malignant melanoma was also invited to attend. First-degree relatives of patients with the dysplastic naevus syndrome (DNS) were invited for a similar examination. DNS was found in 27% of the patients with a family history of melanoma, multiple melanomas, or histological evidence of a dysplastic naevus in association with their melanoma, and in 6% of the remaining patients who were selected at random. DNS was estimated to be present in 12.8% of 17- to 55-year-old patients with cutaneous malignant melanoma in the Perth region, while familial DNS was present in 4.5%. Patients with melanomas with DNS were more likely to be young men and to have numerous naevi, particularly on the lateral surfaces of the arms, shoulders and trunk, than were patients with melanomas without the syndrome.     

Is physician detection associated with thinner melanomas?

CONTEXT: In cutaneous melanoma, tumor depth remains the best biologic predictor of patient survival. Detection of prognostically favorable lesions may be associated with improved survival in patients with melanoma. OBJECTIVE: To determine melanoma detection patterns and relate them to tumor thickness. DESIGN: Interview survey. SETTING AND PATIENTS: All patients with newly detected primary cutaneous melanoma at the Melanoma Center, Johns Hopkins Medical Institutions, between June 1995 and June 1997. MAIN OUTCOME MEASURE: Tumor thickness grouped according to detection source. RESULTS: Of the 102 patients (47 men, 55 women) in the study, the majority of melanomas were self-detected (55%), followed by detection by physician (24%), spouse (12%), and others (10%). Physicians were more likely to detect thinner lesions than were patients who detected their own melanomas (median thickness, 0.23 mm vs 0.9 mm; P<.001). When grouped according to thickness, 11 (46%) of 24 physician-detected melanomas were in situ, vs only 8 (14%) of 56 patient-detected melanomas. Physician detection was associated with an increase in the probability of detecting thinner (< or =0.75 mm) melanomas (relative risk, 4.2; 95% confidence interval, 1.4-11.1; P=.01). CONCLUSIONS: Thinner melanomas are more likely to have been detected by physicians. Increased awareness by all physicians may result in greater detection of early melanomas.     

恶性黑色素瘤细胞角蛋白的表达

目的 对细胞角蛋白(CK)在恶性黑色素瘤的表达情况及其鉴别诊断意义进行研究. 方法 应用免疫组织化学方法检测38例恶性黑色素瘤中CK及S-100蛋白、HMB45、Vimentin表达情况. 结果 CK在恶性黑色素瘤的阳性表达率为32%(12/38),其中原发性恶性黑色素瘤阳性表达率23%(6/26),转移性恶性黑色素瘤阳性表达率50%(6/12);S-100蛋白、HMB45和Vimentin在恶性黑色素瘤阳性表达率分别为87%,76%和97%. 结论 CK在原发性和转移性恶性黑色素瘤有不同程度的表达,CK阳性不能作为诊断癌、排除恶性黑色素瘤的依据.     

The management of primary cutaneous melanoma in Victoria in 1996 and 2000

OBJECTIVE: To describe tumour characteristics and clinical management of melanomas newly diagnosed in 1996 and in 2000--before and after publication of the clinical practice "Guidelines for the management of cutaneous melanoma" by the Australian Cancer Network (1997), and their endorsement by the National Health and Medical Research Council (NHMRC) and republication (1999). DESIGN AND SETTING: Survey of clinicians involved in the management of patients with melanoma sampled from the Victorian Cancer Registry. The Registry is notified of all cases of cancer diagnosed by pathology laboratories and hospitals in both the public and private health sectors in the state of Victoria. PATIENTS: People with a cutaneous melanoma newly diagnosed in 1996 and 2000. All invasive melanomas > 1.50 mm in thickness were included, and for each year random samples were selected of 100 each of invasive melanomas 0.76-1.50 mm in thickness, invasive melanomas < or = 0.75 mm, and in-situ melanomas, plus 50 melanomas of unknown thickness. MAIN OUTCOME MEASURES: Biopsy method, adequacy of pathology reporting, adequacy of definitive excision (compared with margins recommended by the Guidelines), and follow-up procedures. RESULTS: The use of partial biopsies increased between 1996 and 2000. Recommended margins of definitive excision were used in only 33.6% of cases. Margins were smaller than recommended for 36% of in-situ melanomas, risking recurrence of primary melanoma. Documented follow-up examinations for subsequent primary skin malignancy were uncommon (6%). CONCLUSIONS: Many aspects of the management of primary cutaneous melanoma appear not to meet the recommendations of the published Guidelines. Further studies to explore the reasons for failure to meet the Guideline recommendations are needed.     

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.     

Clinicopathological features of and risk factors for multiple primary melanomas

Context  The incidence of multiple primary melanomas ranges from 1.3% to 8.0% in large retrospective reviews; however, the impact of certain risk factors is not understood. Objectives  To determine the incidence of multiple primary melanomas (MPM) from a prospective, single-institution, multidisciplinary database, and to describe the clinical and pathological characteristics and risk factors specific to these patients. Design and Setting  Review of a prospectively maintained database at Memorial Sloan-Kettering Cancer Center in New York, NY. Patients  A total of 4484 patients diagnosed with a first primary melanoma between January 1, 1996, and December 31, 2002. Main Outcome Measures  Incidence of and risk factors for MPM. Results  Three hundred eighty-five patients (8.6%) had 2 or more primary melanomas, with an average of 2.3 melanomas per MPM patient. Seventy-eight percent had 2 primary melanomas. For 74% of patients, the initial melanoma was the thickest tumor. Fifty-nine percent presented with their second primary tumor within 1 year. Twenty-one percent of MPM patients had a positive family history of melanoma compared with only 12% of patients with a single primary melanoma (SPM) (P<.001). Thirty-eight percent of MPM patients had dysplastic nevi compared with 18% of SPM patients (P<.001). The estimated cumulative 5-year risk of a second primary tumor for the entire cohort was 11.4%, with almost half of that risk occurring within the first year. For patients with a positive family history or dysplastic nevi, the estimated 5-year risk of MPM was significantly higher at 19.1% and 23.7%, respectively. The most striking increase in incidence for the MPM population was seen for development of a third primary melanoma from the time of second primary melanoma, which was 15.6% at 1 year and 30.9% at 5 years. Conclusions  The incidence of MPM is increased in patients with a positive family history and/or dysplastic nevi. These patients should undergo intensive dermatologic screening and should consider genetic testing.      

Expression of the Tumor Metastatic Suppressor Gene in Mouse Melanoma Model: Inverse Association to Metastatic Potential

Cancermetastasisisacomplexprocessinwhichtumorcellsofaprimaryneoplasminvadenormaltissues,enterandescapethevascularture,andgeneratesecondarytumorsormetastasessequentialsteps,eachofwhichislikelytoentailtheactivationand(or)repressionofspecificgenesorgeneproducts,dependingontileoriginandtypeoftumor[1'2].Atleast10differentoncogenshavebeenshowntoaugmentthetnetastasesofavarietyoftumorsinexperimentalam--.inals.The"m23isonesuchgenereportedtobedown--regulatedinmetastaticcellsofdifferentrodenttumorsL3].Th…     

葡萄膜黑色素瘤MRI及动态增强研究

目的探讨葡萄膜黑色素瘤的MRI和动态增强表现及其与肿瘤微血管密度的关系。方法回顾性分析经病理证实的20例葡萄膜黑色素瘤的MRI资料,主要研究动态增强扫描的表现,对其手术后标本行免疫组织化学染色计数微血管密度,绘制时间-信号曲线,计算峰值时间、上升斜率、强化率和流出率,分析动态增强参数与微血管密度的关系。结果20例黑色素瘤中,肿瘤位于眼球赤道后方占95％,呈半球形或蘑菇形者占75％,呈短T1信号者占65％,呈短T2信号者占55％,信号均匀者占80％,伴视网膜脱离者占75％;峰值时间为（52.9±13.7）秒,上升斜率为0.62±0.29,强化率0.32±0.13,流出率（42.64±23.16）％,不同病理类型之间上升斜率、强化率有显著性差异（P〈0.05）,峰值时间、流出率无显著性差异（P〉0.05）;微血管密度为43.56±19.89,与峰值时间、上升斜率、强化率和流出率无线性相关关系（P〉0.05）。结论葡萄膜黑色素瘤在MRI上具有典型征象,动态增强能提供定性信息。     

南充地区恶性黑色素瘤115例的临床病理特点分析

目的探讨南充地区恶性黑色素瘤的临床病理特点。方法对我院1974年-2002年间经病理确诊的恶性黑色素瘤115例进行临床病理分析。结果115例中,男62例,女53例。年龄最大79岁,最小4岁,平均51.25岁。高发年龄为40-70岁,共90例,占78.26％。发生在皮肤50例,粘膜50例,其他部位15例。发生在皮肤者以足部为多(22／50),发生在粘膜者以鼻腔为多(22／50)。肿瘤直径2-4cm共76例,占66.09％。镜下易见色素(89例,占77.39)。临床误诊和待诊率达85.22％。结论南充地区恶性黑色素瘤多见于40-70岁。皮肤和粘膜的发生率无差异,皮肤以足部为多,粘膜以鼻腔常见。肿瘤直径2-4cm为多,镜下以色素性为主,临床易误诊。     

中枢神经系统黑色素瘤15例临床分析

目的 探讨中枢神经系统黑色素瘤的诊治方法。方法 分析自1996年12月至2003年2月收治的15例中枢神经系统黑色素瘤患者的临床表现、外科治疗和预后情况。结果 15例黑色素瘤患者中发生于颅内者12例,椎管内者3例。临床表现无特征性。手术全切除5例,大部切除10例。病理检查黑色素瘤10例,脑脊膜黑色素细胞瘤4例,无色素性黑色素瘤1例。10例获得随访,9例死亡,1例恢复正常生活。结论 中枢神经系统黑色素瘤发病率低,误诊率较高,治疗以手术切除为主,结合放疗或γ刀治疗。本病预后差。     

Prevalence of left-sided melanomas in an Irish population

Background

A predominance of melanomas on the left side of the body has recently been described. No associations between tumour laterality and gender, age or anatomical site have been identified.

Aim

The aim of this study was to investigate the prevalence of left-sided melanomas in an Irish population and to examine potential associations with various patient and tumour characteristics.

Methods

A retrospective chart review of patients with cutaneous melanoma who were treated over a 10-year period was carried out. Lateral distribution of melanoma on either side of the body was compared using χ² analysis and evaluated by gender, age group, anatomic location, histologic subtype and Breslow depth.

Results

More melanomas occurred on the left side (57%, P = 0.015), and this finding was particularly significant in females. For both genders combined, there were no statistically significant differences in laterality by age group, anatomic location, type of melanoma and Breslow depth. There were significantly more superficial spreading melanomas on the left side in both men and women.

Conclusions

This study demonstrates a predominance of left-sided melanomas in Irish patients. While a number of demographic and molecular associations have been proposed, further research is required to fully explain this phenomenon.     

MMP-2和MMP-9在皮肤恶性黑色素瘤中的表达及意义

目的研究明胶酶（MMP-2和MMP-9）在皮肤黑色素瘤和色素痣组织中的蛋白表达及其意义。方法应用免疫组织化学S．P法检测90例皮肤黑色素瘤和43例皮肤色素痣组织MMP．2和MMP-9的表达情况,分析它们与患者临床病理特征的关系。结果皮肤黑色素瘤组织MMP-2和MMP-9蛋白表达阳性率分别为50．0％和55．6％,显著高于色素痣的阳性率27．9％和25．6％（P〈0．05和P〈0．01）;黑色素瘤MMP-2和MMP-9蛋白表达均与肿瘤的浸润深度和淋巴结转移呈正相关（均P〈0．05）。结论皮肤恶性黑色素瘤MMP-2和MMP-9表达状况与肿瘤侵袭、转移呈密切相关,提示MMP-2和MMP-9可能在黑色素瘤发生发展过程中发挥了重要作用。     

Expression of phosphorylated-STAT3 and osteopontin and their correlation in melanoma

The expressions of p-STAT3 and osteopontin in 22 cases of normal nevi and 43 cases of malignant melanoma were immunohistochemically detected, and the correlation between p-STAT3 and osteopontin in malignant melanoma and the correlations of p-STAT3 （or osteopontin） with invasion, metastasis and thickness of malignant melanoma were examined. The results showed p-STAT3 was expressed in 2 of 22 cases of normal nevi and 30 of 43 cases of malignant melanoma, while osteopontin was expressed in 3 cases of normal nevi and 29 cases of malignant melanoma. The expressions of p-STAT3 and osteopontin in melanoma were significantly higher than that in benign nevi. There existed significant correlations between the expression of p-STAT3 and that of osteopontin in melanoma. Furthermore, the expression rates of p-STAT3 were significantly higher in invasive or metastatic melanomas than that their non-invasive or non-metastatic counterparts, and the expression rates of osteopontin were significantly higher in invasive melanomas than that in non-invasive ones. It is concluded that p-STAT3 and osteopontin may play important roles in the pathogenesis of malignant melanoma.     

Detection of human malignant melanoma with gallium-67 citrate and N-isopropyl-(I-123) p-iodo-amphetamine

Using N-isopropyl-(I-123)p-iodo-amphetamine (I-123 IMP) and gallium-67 citrate, it was possible to detect human malignant melanomas. I-123 IMP imaging was helpful in detecting melanomas occurring in the legs and arms, and the 4 hour image was better than the 1 hour image. Moreover, while gallium scintigraphy more clearly detects human malignant melanoma, I-123 IMP allows for the detection of human malignant melanoma within 1 hour after administration.     

恶性黑色素瘤免疫组化观察——附12例报告

目的： 探讨波形蛋白（Ｖｉｍｅｎｔｉｎ） 、Ｓ １００ 、ＨＭＢ４５ 、细胞角蛋白（Ｃｙｔｏｋｅｒａｔｉｎ） 的表达在恶性黑色素瘤（ 下称恶黑） 鉴别诊断中的意义。方法：１２ 例恶黑取石蜡切片各一张,用免疫组化链霉素 生物素（ＬＳＡＢ） 法,分别作Ｖｉ ｍｅｎｔｉｎ 、ＨＭＢ４５ 、Ｓ １００ 、Ｃｙｔｏｋｅｒａｔｉｎ 染色。结果： 每例Ｖｉｍｅｎｔｉｎ 、Ｓ １００ 、ＨＭＢ４５ 标记均呈阳性表达。Ｃｙｔｏｋｅｒａｔｉｎ 表达情况为,皮肤原发恶黑９ 例中有４ 例阳性,阳性者中２ 例为无色素性恶黑;３ 例淋巴结内转移性恶黑１ 例阳性。结论： Ｃｙｔｏｋｅｒａｔｉｎ 阳性不能排除恶黑的诊断     

Subungal melanoma

Subungal melanoma is a rare condition accounting for 1–3% of all melanomas. It has been associated with a poor prognosis, with a 10–30% 5 year survival usually attributed to the delay in diagnosis. Early biopsy of suspicious lesions followed by amputation of the digit in those proving positive is the treatment of choice.     

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.