Palliative cryosurgery for oral cavity malignant melanoma: a case report

A case of unresectable malignant melanoma of the oral cavity, treated with cryosurgery, is reported. A complete remission of 10 months was obtained, followed by 2 local recurrences, both treated successfully (CR: 9 and 4 months). At 23 months after the first treatment, a new local recurrence was considered untreatable.     

氩氦刀治疗恶性肿瘤细胞免疫功能变化的临床分析

目的探讨恶性肿瘤患者经氩氦刀治疗前后T细胞亚群的变化。方法选取2005年6月-2006年12月的患者,均经病理诊断为Ⅲ期或Ⅳ期的晚期恶性肿瘤,105例患者瘤灶共计109个。病例选择标准：患者预期生存期大于3个月,实验期间均未接受氩氦刀以外的其他治疗。氩氦刀治疗前1周及治疗后1-2周收集标本,做T细胞亚群分析,外周血T细胞亚群CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋采用流式细胞术检测。结果术后3-12个月复查CT示肿瘤明显缩小,部分患者肿瘤消失。恶性肿瘤患者在氩氦刀治疗后外周血CD3^＋、CD4^＋、CD4^＋／CD8^＋比治疗前明显升高（P〈0．05）。结论恶性肿瘤患者经氩氦刀治疗后可以增强细胞免疫功能,提高抗肿瘤能力。     

Bronchial malignant melanoma

We describe a case of malignant melanoma presenting initially as an endobronchial lesion located in the left main bronchus causing total atelectasis. This resolved with radiation therapy. Widespread metastases developed shortly thereafter. The differential diagnosis of primary and metastatic bronchial malignant melanoma is discussed. Other isolated case reports are reviewed.     

Sentinel lymph node detection by lymphoscintigraphy in malignant melanoma

AIMS AND BACKGROUND: Sentinel lymph node (SLN) detection is currently employed in patients with malignant melanoma (MM) to spare them unnecessary lymph node dissection. METHODS AND STUDY DESIGN: We investigated 241 patients (130 men and 111 women, median age, 50 years (range, 14-92) with MM (192 before and 51 after surgical biopsy); two of them had more than one melanoma lesion. In each patient approx. 10 MBq of 99mTc Nanocoll in 0.1 mL (Nycomed Amersham Sorin; particle size range, 3-80 nm) was injected intradermally around the MM lesion or surgical scar. Dynamic acquisition was performed for 20 minutes (20 frames/min) and the study was concluded within four hours of injection. Using an external radioactive marker, the skin over the SLN was marked with China ink. RESULTS: 294 SLNs were scintigraphically identified: 117 in the inguinal region, 147 in the axillae, four in the submandibular region, three in the laterocervical region and 23 at other sites. In two patients no drainage was detected. In 43 patients more than one sentinel node was identified. In 13 patients with lesions located in the trunk the tracer drained towards multiple lymph node stations or unexpected lymph nodes (nine cases). Histology and immunohistochemistry diagnosed MM in 25 SLNs; 19 were positive for metastasis with hematoxylin-eosin staining, five with Hmb45 and one with CD68 immunostaining. All 25 detected lymphatic basins were excised. In nine of these basins there was metastatic involvement of at least one other lymph node besides the SLN. During follow-up which ranged from six to 86 months, metastatic disease was found in only one patient with a histologically negative SLN six months after surgery. CONCLUSIONS: This study confirms the utility of scintigraphic SLN detection in patients with MM. In most of the cases the procedure led the surgeon to evaluate the drainage area, which is unpredictable for lesions in the trunk and may be difficult to delineate using only patent blue dye. Furthermore, in approximately 10% of cases we observed dual drainage from individual lesions, mainly those located on the trunk. We will proceed to compare the results obtained during follow-up with those of an investigational group of patients with melanoma who were not subjected to lymphoscintigraphy for SLN detection in order to obtain well-founded information on the prognostic value of this technique.     

Integrin signaling in malignant melanoma

Cell adhesion and migration are essential for embryonic development, tissue regeneration, but also for tumor development. The physical link between the extracellular matrix (ECM) and the actin cytoskeleton is mainly mediated by receptors of the integrin family. Through signals transduced upon integrin ligation to ECM proteins, this family of proteins plays key roles in regulating tumor growth and metastasis as well as tumor angiogenesis. During melanoma development, changes in integrin expression, intracellular control of integrin functions and signals perceived from integrin ligand binding impact upon the ability of tumor cells to interact with their environment and enable melanoma cells to convert from a sessile, stationary to a migratory and invasive phenotype. Antagonists of several integrins are now under evaluation in clinical trials to determine their potential as therapeutics for malignant melanoma and other kinds of cancer.     

Estrogen receptor in malignant melanoma

The significance of an estrogen binding protein (ER) in malignant melanoma remains controversial. We have prospectively assayed for ER on 141 patients with malignant melanoma and correlated the presence of the ER with known prognostic variables. The overall incidence of ER was 43%. The incidence of ER in males was 38.7% and 50% in females (not significant). There is an increased incidence of ER+ melanoma in women with extremity lesions (P = .08). The disease-free interval (DFI), survival, and recurrent interval were 42.0 +/- 4.0, 52.3 +/- 4.3, 13.7 +/- 1.7 months in ER- patients; 63.7 +/- 11.6, 76.1 +/- 11.4, 26.5 +/- 7.3 months in ER+ patients (1 to 10 fmol/mg cytosol protein), and 69.8 +/- 17.9, 102.7 +/- 27.9, 29.4 +/- 9.9 months in ER+ patients (greater than 10 fmol/mg cytosol); respectively. When ER+ groups were combined, the DFI in women with ER+ lesions was significantly longer than those with ER- tumors (P less than .05). Cox multivariate analysis demonstrated that ER status is a significant variable of survival along with thickness level and nodal status. These observations suggest that ER may be a marker for a more biologically indolent melanoma.     

Integrin expression in malignant melanoma

Invasion of melanoma cells into the underlying interstitial stromal matrix is the initial step for subsequent local and distant metastasis. The invading tumor cell must interact with the extracellular matrix during the early stages of invasion and later during penetration of lymphatic and blood vessels. This interaction with different types of extracellular matrix predicts that the invasive cell must possess surface adhesion receptors with diverse ligand specificities, including the capacity to bind different types of collagens and adhesive glycoproteins. Metastatic melanoma cells do in fact express multiple adhesion receptors, including several of the receptors from the integrin family of heterodimers. The integrin receptors can be either extremely specific for a single ligand or capable of binding multiple ligands. It is likely that the tumor cell's repertoire of adhesion receptors may influence not only its adhesive properties but its metastatic characteristics as well. There is evidence that normal melanocytes have an integrin profile distinct from that of melanoma cells. In particular, melanocytes adhere poorly to laminin while metastatic melanoma cells bind well to this ligand. This difference in adhesion between the two cell types appears to reflect the fact that melanoma cells express a melanoma-specific integrin (% MathType!MTEF!2!1!+-% feaafeart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXafv3ySLgzGmvETj2BSbqefm0B1jxALjhiov2D% aebbfv3ySLgzGueE0jxyaibaiGc9yrFr0xXdbba91rFfpec8Eeeu0x% Xdbba9frFj0-OqFfea0dXdd9vqaq-JfrVkFHe9pgea0dXdar-Jb9hs% 0dXdbPYxe9vr0-vr0-vqpWqaaeaabiGaciaacaqabeaadaqaaqGaaO% qaaiaadggadaWgaaWcbaGaamODaaqabaGccqaHYoGydaWgaaWcbaGa% aG4maaqabaaaaa!40CF!\[a_7 \beta _1 \]) that binds laminin and is not detectable in normal melanocytes. The presence of increased laminin receptors and enhanced laminin binding in melanoma cells may contribute to the malignant phenotype.     

Mucosal metastases in malignant melanoma

BACKGROUND: We present the case of a patient with malignant melanoma stage IV according to the American Joint Committee on Cancer (AJCC) classification and an unusual pattern of metastasis to the mucosa of the esophagus, the stomach, the bladder and the palatine tonsil. CASE REPORT: A 38-year-old male patient with metastatic malignant melanoma of stage III (AJCC) was admitted for initiation of adjuvant therapy. 4 months earlier a primary melanoma of the left upper leg had been excised and 2 months later the patient had undergone a left inguinal lymph node dissection revealing 2 metastatic lymph nodes. On admission the patient complained of a sore throat and right cervical lymphadenopathy. He underwent a tonsillectomy and a lymphadenectomy which both revealed melanoma metastases. A PET scan using F-18-fluorodeoxyglucose (FDG) showed focal metabolic activity in the middle mediastinum. Two cycles of dacarbazine (DTIC) chemotherapy were performed during which the patient developed cutaneous metastases, dyspepsia, and mild hematemesis. Gastroscopy revealed bleeding from mucosal metastases of the esophagus and stomach. A few weeks later the patient developed macroscopic hematuria. A cystoscopy was performed and showed metastases to the mucosa of the bladder. Nutrient vessels of these bladder metastases were embolized in order to control bleeding. The patient is currently alive with progressive disease. RESULTS: This case presents common and uncommon sites of metastatic melanoma to the mucosa with the typical clinical manifestations in a single patient.     

HLA-G expression in malignant melanoma

Both, the expression of HLA-G (a non-classical HLA class I molecule) and the loss of classical HLA class I molecules enable tumor cells to evade from immunosurveillance of the host. Whereas HLA-G down-modulates the immune functions of all cells participating in the immune defence mechanisms, defects on HLA class I expression result in the resistance of tumor cells to cytotoxic T lymphocytes attacks. This contribution reviews the HLA-G expression pattern in malignant melanoma lesions, its correlation to the loss of classical HLA class I antigens, and new aspects of HLA-G regulation.     

Cutaneous malignant melanoma in Europe

Cutaneous malignant melanoma is on the rise in fair skinned societies. Both its incidence and mortality rates have been increasing in Europe over the past decades, the latter seem to stabilise in Scandinavia. The main cause of melanoma is intermittent exposure to ultraviolet radiation, especially in combination with endogenous factors like skin type and genetic predisposition. Evidence on an association between sunbed use and melanoma is inconclusive, but seems to point to a slightly increased risk associated with sunbed use. Within Europe, considerably variation in patterns of melanoma incidence and mortality existed. In this paper, we discuss the possible explanations for the observed trends and options for primary and secondary prevention. Early detection seems the most promising way to combat the relatively poor survival rates in Southern and Eastern Europe.     

BRAF癌基因在黑色素瘤中的研究

 BRAF基因是黑色素瘤突变率最高的基因，在黑色素瘤的发生、发展和浸润转移中发挥重要作用。BRAF基因在黑色素瘤不同临床表型、临床病理分型及不同分期间突变率存在差异，提示BRAF基因与黑色素瘤生长及预后判断有一定相关性，同时针对BRAF基因突变的分子靶向治疗已成为当前黑色素瘤治疗的新方向。     

Intracranial metastases of malignant melanoma treated by surgery

Metastases in 25 patients with intracranial metastases from malignant melanoma were extirpated. Two patients had a second operation after six and ten months because of tumor recurrence. Single brain metastaσes were found in 20 and multiple in five patients. The interval between the primary tumor and the intracranial metastases varied from 17 years to six months. Three patients died due to complications from surgery. The median survival time was five months (mean survival ten months). Complete relief of symptoms was observed in 17 and partial relief in two patients. The quality of life was improved in 17 patients and 14 of these 17 went back to their ordinary occupation. The indications for neurosurgery are restricted in patients with extracranial or with multiple intracranial metastases.