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.     

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.     

DETECTION OF EARLY LESIONS OF "UNGUAL" MALIGNANT MELANOMA

Background. The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, becuase at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis. Methods. For 3 years, all patients with nail pigmentation at the dermatology clinic were screened for five specific criteria for the diagnosis of early lesions of malignant melanoma. Histologic examination was performed on 10 of 29 lesions. Results. Five of the 29 lesions were advanced malignant melanoma, easily diagnosed clinically. Two of the remaining 24 lesions fulfilled most of our clinical criteria of early malignant melanoma of the nail apparatus; that is, they appeared as melanonychia striata during adulthood, were wide in breadth measuring 9 and 11 mm, and showed variegated shades of brown. Periungual pigmented macule (Hutchinson's sign) was observed in one of the two cases. Total resection of the lesions was performed, followed by skin grafting. Conclusions. Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed only in the epithelia of the nail matrix and of the nail-bed, confirming that these lesions were “ungual” malignant melanoma in situ. Such an early lesion of malignant melanoma of the nail apparatus can be completely cured with conservative excision, and the phalanx of the affected digit can be preserved.     

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.     

MALIGNANT MELANOMA IN CHILDREN

Background. While significant risk factors for malignant melanoma may initially develop or are first seen in childhood, the actual occurrence of this neoplasm in prepubertal children is uncommon. Methods. A retrospective study of malignant melanoma in Puerto Ricans up to 16 years of age occurring from 1973 to 1990 was carried out by identifying those cases in the Puerto Rico Cancer Registry. Results. A total of seven cases were found consisting of three boys and four girls with ages ranging from 22 months to 16 years and comprising 0.94% of the total melanomas. In three of the seven cases, there was a history of a previously existent small congenital melanocytic nevus on the area. Three cases were Clark's level I, two level II, and in two cases with proved metastatic disease, Clark's level of invasion were not reported. Those cases with Clark's level I and II had a 100% 5-year survival. Conclusions. Although rare, malignant melanoma in children can be as aggressive as in adults. Among the known factors predisposing to malignant melanoma, three out of seven cases developed within a small congenital nevus, two of which occurred during the first decade of life. Due to the rarity of this event in our population, it appears unreasonable to excise all small congenital nevi during the first decade of life. Even for those who advocate excision of all small congenital nevi, the evidence at present suggests that such small nevi very rarely undergo malignant change before puberty and therefore a policy of observation in childhood and offering excision around the time of puberty is perfectly logical.     

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.     

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).     

SUBUNGUAL MALIGNANT MELANOMA: A DISEASE ENTITY SEPARATE FROM OTHER FORMS OF CUTANEOUS MELANOMA

The characteristics and results of treatment of 30 patients with subungual malignant melanoma treated at the Sydney Melanoma Unit were studied. It was found that in several major respects subungual melanoma differed from other forms of cutaneous melanoma. Patients with subungual melanoma were considerably older than those with either superficial spreading or nodular melanoma and there was a preponderance of men with subungual melanoma of the upper extremity. Independent prognostic factors (such as tumour thickness) which are important in determining survival in patients with superficial spreading or nodular melanoma, had little consequence in patients with subungual melanoma. Despite the fact that the vast majority of subungual melanomas were very thick and ulcerated due to the delay in correctly diagnosing the disease clinically, overall survival rate was reasonably good, providing patients had an amputation of the entire digit together with either a prophylactic or therapeutic lymph node dissection. These findings indicate that subungual melanoma is a disease entity separate from other forms of cutaneous melanoma and that radical surgery is essential in all subungual melanoma patients.     

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.