Clinical and therapeutical considerations on a case of conjunctival melanoma

The authors report a case of limbal conjunctival melanoma treated in a conservative manner. The choice of such a therapy was based not only on clinical examinations and review of literature, but also and mainly on the intraoperative histological examination that showed no involvement of the conjunctival deeper layers.     

Desmoplastic malignant melanoma presenting with orbital involvement

Desmoplastic malignant melanoma (DMM) is a rare variant of spindle cell melanoma. We report a case of DMM of the forehead secondarily involving the orbit. The diagnosis was based on light microscopic features, including prominent peripheral cell nest formation and spindle cell fascicles in densely collagenous stroma. Immunohistochemical studies showed strong uniform staining for S100 antigen throughout the tumour. It was negative for HMB 45, smooth muscle actin, desmin, cytokeratins and Type IV collagen. Electron microscopy showed neither melanosomes nor myelin figures. The clinical and histological characteristics of desmoplastic malignant melanoma, and its differential diagnosis of malignant schwannoma, are discussed. DMM has a poor prognosis, since it tends to invade deeply, recur locally and metastasise readily.     

Klinische Wertigkeit einer dermatoskopischen Klassifikation von Clark‐Nävi

Background and objectives: The aim of this study was to evaluate the practical value of the dermatoscopic classification of Clark nevi Patients and methods: Dermatoscopic images of 268 lesions clinically and dermatoscopically diagnosed as Clark nevi were presented to 2 dermatologists without knowledge of the histological diagnosis. The dermatologists evaluated the lesions according to a simplified version of the classification scheme for Clark nevi proposed by Hofmann‐Wellenhof and differentiated between 12 different types of Clark nevi. Results: The most common type of Clark nevus was the reticular‐homogenous type (n = 64, 23,9 %), followed by the globular‐homogeneous type (n = 32, 12 %) and by the homogenous type (n = 30, 11,2 %). The overall inter‐rater agreement between the examiners was moderate to good (kappa = 0,58). The highest level of agreement was found for the peripheral hyperpigmented type (kappa = 0,83). Histologically, 17 lesions (6,3 %) were diagnosed as melanomas. The frequency of melanoma was highest among the peripheral‐hyperpigmented type for one observer and among the homogenous type for the other observer. No melanoma was found among the globular, reticular‐globular, and the central‐hyperpigmented types. Conclusions: A dermatoscopic classification of Clark nevi is practically feasible and allows – to some extent – a risk stratification of Clark nevi, which could be useful for clinical management.     

Molecular oncogene markers and their significance in cutaneous malignant melanoma

Background: Oncogenes and other molecular tumor markers that predict tumor aggressiveness may allow individualization and optimization of surgical therapy of intermediate-thickness malignant melanoma. We examined the expression of selected markers, including the HLA-DR antigen, the heat shock protein-70 (HSP-70), and the c-myc oncogene in primary melanoma and regional nodes and related these findings to metastatic potential and survival. Methods: Forty patients with primary melanoma (1.5–4.0 mm) were studied, all of whom had prophylactic lymph node dissection and were followed for 18 months to 7 years. The primary tissue and nodes were examined using immunohistochemical techniques for the presence of HLA-DR antigen and HSP-70 protein and the expression of the c-myc oncogene. Results: Of 40 patients, there were 23 with lesions 1 to 2.9 mm thick and 17 with lesions 3 to 4 mm thick. Nodal metastases were present in 25 of the 40 patients who had elective node dissection. HLA-DR antibody stained the primary tumor in 10 patients (25%), but there was no correlation with survival in this group. HLA-DR antibody stained the stroma and cellular infiltrates surrounding the primary tumor in 28 of 40 patients; in this group there was a correlation of HLA-DR staining of the peritumoral stroma with improved survival overall. HLA-DR staining of the peritumoral stroma also influenced survival when patients were stratified by tumor thickness groups 1 to 2.9 mm and 3 to 4 mm and presence of nodal metastases. HSP-70 was demonstrated in the primary tumor in 25% of patients, who were also shown to have significantly improved survival when compared with those whose primary tumor did not stain with HSP-70. C-myc was expressed in the primary tumor in 25%, but showed no correlation with survival. None of these proteins correlated with or predicted the presence of nodal metastases. Conclusion: We conclude that the use of specific molecular-oncogene markers in intermediate-thickness primary melanoma may identify patients at high risk for conventional treatment failure and reduced survival who may profit from more aggressive surgery, adjuvant therapy, or both.Presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

基因转移FasL治疗人黑素瘤的实验研究

目的探讨体内外基因转移F as配体(F as-ligand,F asL)对恶性人黑素瘤细胞凋亡的影响。方法用携带人F asL cDNA的缺陷型重组腺病毒(A d-F asL),在体外转导两株黑素瘤细胞,并使其表达;通过流式细胞仪、RT-PCR法进行F as/F asL表达检测,TUNEL法及荧光显微镜相关凋亡检测、分析。建立人黑素瘤裸鼠模型,并对其进行体内疗效观察及病理学检查。结果流式细胞仪和RT-PCR检测两株黑素瘤细胞表面均表达F as,不表达F asL,而A d-F asL转导的两株黑素瘤细胞均能表达F asL;A d-F asL能显著诱导两株黑素瘤细胞在体外凋亡或抑制其生长。体内疗效观察黑素瘤荷瘤鼠模型治疗组瘤重(0.48±0.16)g与对照组瘤重(1.02±0.19)g相比,差异有显著性(P<0.05)。肿瘤组织形态学检查,治疗组可见肿瘤细胞凋亡坏死区及炎性细胞浸润。结论F asL基因重组腺病毒在体内外均具有显著诱导人黑素瘤细胞凋亡的效果。     

The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases

BACKGROUND: Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. METHOD: Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions. RESULTS: Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm). CONCLUSIONS: The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases.     

106Ru/106Rh plaque radiotherapy for malignant melanomas of the choroid

Therapeutic results are presented with follow-up examinations of at least 5 years (min. 5 years, max. 22 years) after ¹⁰⁶Ru/¹⁰⁶Rh plaque radiotherapy of posterior uveal melanomas. Out of 227 patients 146 (= 64.3%) could be treated successfully, 37 (= 16.3%) had to be enucleated and are alive, 44 (= 19.4%) died from metastases and 40 (17.6%) from other causes. 75.0% of all small melanomas (T1a) showed an excellent regression pattern to flat scars. Five years after treatment the survival rate was 83.7% (deaths from any causes) respectively 88.2% (deaths from metastases only) and 64.8% (deaths from any causes) respectively 79.7% (deaths from metastases only) ten years after irradiation. ¹⁰⁶Ru/¹⁰⁶Rh plaque radiotherapy can be recommended for small (Tla, b) and medium sized (T2) choroidal melanomas.     

脉络膜黑色素瘤脱色素处理后Caspase-3的免疫组化研究

目的 观察凋亡基因Caspase-3在脉络膜黑色素瘤(choroidal melanoma)中的表达及分型与细胞凋亡的关系。方法 收集20例脉络膜黑色素瘤标本，对其进行Caspase-3免疫组织化学染色，观察表达情况及染色强度。结果 Caspase-3在脉络膜黑色素瘤有较好的表达，在梭形细胞型中5例／6例呈阳性表达，在混合型中6例／8例呈阳性表达，在上皮样瘤细胞型中3例／4例呈阳性表达，在坏死型中1例／2例呈阳性表达，且在各型之间没有显著性差异(P＞0．05)。结论 凋亡在脉络膜黑色素瘤中存在；Caspase-3在脉络膜黑色素瘤的发生发展中起重要作用。     

Desmoplastic malignant melanoma: An aggressive tumor

Summary The clinical features and histological appearance of desmoplastic malignant melanoma are presented. Aggressive surgical management and close follow-up are mandatory if this highly aggressive tumor is to be controlled. Despite this, the prognosis is poor.