Survey of treatment practices for neonatal seizures

While the incidence of malignant melanoma is much lower in Japanese than in Caucasians, the commonest site of melanoma in Japanese has been reported to be the acral regions of the limbs. The survival rate for acral and nodular melanoma observed at the Department of Dermatology, Tohoku University Hospital in Sendai, Japan from 1969 to 1990 was reviewed. Among 150 melanoma patients 125 (83%) and 17 (11%) had primary cutaneous melanoma and mucous membrane melanomas, respectively. Frequent sites for cutaneous melanomas were the sole (31%) and subungual regions (15%). Comparison of the stages of plantar melanoma at diagnosis showed that the proportion of stages III and IV decreased after 1980 with a corresponding increase in those with a tumour thickness of less than 4 mm (stage II). Concurrently, the prognosis of plantar melanoma has improved; the 5-year survival rate in each of the three periods 1969-75, 1976-80 and 1981-85 was 21, 70 and 90%, respectively. This was also the case with subungual melanoma. Such improvements in the prognosis are thought to be mainly due to early detection through the growing public awareness of this life-threatening disease. By contrast cases of nodular melanoma increased sharply after 1980. Among these, the high proportion of patients in advanced stages (stages III and IV) remained static even after 1980, with a resultant low 5-year survival rate in the above mentioned periods of 33, 38 and 18%, respectively.     

Brain enzyme activities after intracerebroventricular injection of streptozotocin in rats receiving acetyl-L-carnitine

BACKGROUND: Scant data exists on melanoma in blacks from Africa. This study was undertaken to define factors affecting outcome of blacks from South Africa with melanoma. STUDY DESIGN: A retrospective analysis of the management and outcome of 63 black patients with malignant melanoma treated at a major referral center during a 14 year period is presented. Data evaluated included patient demographic and clinical characteristics, stage at presentation, tumor site, histologic type, treatment, and subsequent cure. Survival curves were calculated for stage and site of disease. RESULT: The mean age at presentation of the 39 women and 24 men was 60.5 years (range of 30 to 85 years), with a peak incidence in the sixth decade. The foot was the most common site of disease (45 patients). Seven patients had subungual melanoma, seven had primary mucosal lesions, and in six, the primary lesion could not be found. Thirty patients presented with stage I disease, two with stage II, 23 with stage III, and nine with disseminated metastatic disease. Acral lentiginous melanoma was the most common histogenetic type (34 patients), nodular melanoma occurred in ten patients, and superficial spreading melanoma occurred in three patients. The mean Breslow depth was 6.15 mm (range of 1 to 25 mm). Patients with localized disease were treated by wide local excision and split skin graft, while patients with melanoma in the nailbed were treated by amputation of the involved digit. Sixteen patients are alive after a mean follow-up period of 82.1 months, 44 have died after a mean of 12.7 months, and five patients have been unavailable for follow-up evaluation. CONCLUSIONS: The poor prognosis in black patients in South Africa is the result of delayed presentation with thick primary lesions and advanced disease. An active education program may reduce mortality by detecting the disease earlier.     

Survival analysis in patients with cutaneous malignant melanoma

INTRODUCTION: Cutaneous malignant melanoma (MM) takes only 3% of all malignant tumours of the skin, but for reason of its increased frequency and pronounced tendency to rapid growth and metastases, it causes 60% of total lethal outcomes due to malignant tumours of the skin [1]. Primary MM is a diagnostic problem because of the great variety of its clinical features. Asymmetric configuration, irregular border, speckled color(r)diameter of more than 6 mm, and elevation of the surface, suggest suspicion of malignant alteration, but even then misdiagnosis is possible. For the final diagnosis of MM histopathological confirmation is necessary. The method to use is the extensive excisional biopsy of the lesion and its borders [2]. Histopathological diagnosis is based on microscopic findings which include: histogenetic type of MM, tumour thickness according to Breslow, level of invasion according to Clark, presence of ulceration, grade of lymphocyte infiltration, mitote rate, type of cells, presence of melanin in cells [2, 3]. PATIENTS AND METHODS: A five-year survival of patients with cutaneous malignant melanoma (MM) was studied according to sex, age and distinct features of the tumour: site, type of initial therapy, stage of the disease, time from the first signs of the disease to diagnosis of MM, histological findings (histogenetic type, Breslow's tumour thickness, Clark's level of invasion, presence of ulceration, degree of lymphocyte infiltration, number of mitoses, type of cells, intensity of pigmentation) and presence of metastases. The retrospective study included 336 patients with cutaneous MM. There were 185 female (55.1%) and 151 male patients (44.9%), aged 14-83 years, mean age 48.8 years, who were treated at the institute of Oncology and Radiology in Belgrade from 1978 to 1990. The mean follow-up was 60 months (1-144 months). Melanoma in situ had 16 (4.1%) patients. Stage I had 45 patients (14.1%), stage II 163 (48.5%), stage III 83 (24.7%) and stage IV 29 (8.6%) patients. Acral location on hands and feet had 40 (11.9%) patients, on head and neck 36 (10.7%), on the trunk 146 (43.5%) and on the extremities (except hands and feet) 114 (33.9%) patients. Nodular melanoma (NM) was the most frequent histogenetic type revealed in 150 (44.6%) patients, superficial spreading melanoma (SSM) in 105 (31.1%) patients, acral melanoma (AM) in 39 (11.5%) and lentigo malignant melanoma (LMM) in 32 (9.4%) patients (Table 1). Five-year survival rate was calculated according to Kaplan-Meier's method and significance of the difference between some categories was tested by Long-Rank's test; the significance less than 0.05 was accepted. RESULTS: Statistically highly significant differences in a five-year survival (p < 0.01) were related to sex p = 0.0005, age p = 0.0017, tumour site p = 0.0025, initial therapy p = 0.0036, stage of MM p = 0.0000, histological features of the tumour p = 0.0000 and presence of metastases p = 0.0000. A better five-year survival prognosis was found in female patients (64.5%) compared to male patients 44.5%, aged 27-46 years (87.3%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (66.7%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (65.7%) compared to patients with melanoma on the trunk or acral melanoma (47.3%). Higher survival was recorded in the group of patients with the tumour 1.5-3 mm thick, in whom the tumours was excised and regional nodes dissected as the primary therapy (66.9%) compared to those who underwent excision of the tumor only (48.8%). A five-year survival of patients with MM in situ was 100% for those in stage I; 85% in stage II; 42% in stage III, 16% and 0% in stage IV. The patients in whom the diagnosis of MM was established within 10 months after the first signs of the disease had significa     

Melanoma in Togo. A retrospective study over 20 years

INTRODUCTION: The malignant melanoma is a rare malignant tumour in black patients, but it is common in white patients. MATERIAL AND METHODS: Medical records were reviewed retrospectively during 20 years (1973-1992) to determine the epidemiological features of malignant melanoma in Togo. RESULTS: During this period 63 cases (31 males and 32 females) of malignant melanoma were histologically diagnosed; an average of 3.15 cases each year. The tumor takes place preferably on the feet 40 cases (63.49%), hands 15 cases (19.04%), legs and thigh 10 cases (15.87%). CONCLUSION: The results of this study confirm the particularity of malignant melanoma in black subjects: its rarity and the feet localizations.     

A phase II trial and pharmacokinetic analysis of 96-hour infusional paclitaxel in patients with metastatic colorectal cancer

AIMS: To carry out a retrospective study of male breast cancer over a 22-year experience. METHODS: Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. RESULTS: In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P<0.001). In these patients, univariate analysis demonstrated that axillary status (relative risk of death in positive status vs. negative=3.6), tumour size (relative risk in T3 vs. T1-2=2), surgical treatment type (relative risk in simple mastectomy vs. radical mastectomy=1.9) and adjuvant chemotherapy (relative risk if no chemotherapy=1.4) were statistically significant factors associated with survival. CONCLUSIONS: Cox's regression model revealed that axillary status, tumour size and type of surgical treatment were the most important independent prognostic factors (P<0.001).     

Results of treating forearm bone shaft fractures with a 3.5 mm self compressive plate]

Elevated levels of the phaeomelanin metabolite 5-S-cysteinyldopa and the eumelanin metabolite 6-hydroxy-5-methoxyindole-2-carboxylic acid in urine and serum have been shown in previous studies to correlate with disseminated malignant melanoma. Immunohistochemical detection of S100B protein is an acknowledged method for the diagnosis of malignant melanoma, and it has been suggested that rising serum levels of S100B protein are associated with the survival rate of patients with malignant melanoma. In the present study serum levels of S100B protein and urinary concentrations of 5-S-cysteinyldopa and 6-hydroxy-5-methoxyindole-2-carboxylic acid were measured in 91 patients with histopathologically verified malignant melanoma. At the time of sampling 13 patients were in clinical stage I, 13 in stage II and 65 in stage III. The urinary levels of the melanin metabolites were determined by automated high performance liquid chromatography, and the serum levels of S100B protein by an immunoradiometric assay with two monoclonal antibodies. The overall survival rate was most strongly associated with the serum levels of S100B protein (P < 0.001), but there was also a significant correlation to urinary levels of 5-S-cysteinyldopa (P < 0.001). A corresponding association with urinary levels of 6-hydroxy-5-methoxyindole-2-carboxylic acid was found in only a very few patients with extremely high urinary concentrations. A statistically significant increase in relative hazard was found for S100B protein levels exceeding 0.6 microgram/l (P < 0.001), and predictably for patients in clinical stage III (P < 0.001). An analysis of S100B protein levels in patients in clinical stage III showed a significant correlation to survival (P = 0.005). Our study suggests that of the three biochemical tumour markers, S100B and to a lesser extent 5-S-cysteinyldopa have the greatest potential to be used as predictors of survival prognosis in patients with malignant melanoma.     

Subungual pigmented nevus: evaluation of DNA ploidy in six cases

The discrimination between subungual pigmented nevus and subungual melanoma in situ is still a clinical problem. We measured DNA ploidy in six cases of subungual melanotic lesions which exhibited the features of subungual pigmented nevus or lentigo simplex histologically. Five cases presented a diploid pattern with or without a slight increase of hyperdiploid cells. One case presented a polyploid pattern; it also exhibited histologically abnormal melanocytes with large nuclei and pigment-filled elongated dendrites. The DNA ploidy pattern and histologic features suggest that the lesion of this latter case contains abnormal melanocytes which probably have the potential to undergo a malignant transformation into a subungual melanoma. DNA ploidy analysis, therefore, is likely to provide information for evaluating the biologic behavior of subungual melanotic lesions.     

TNM classification of malignant melanoma and non-melanoma skin cancer

We abide by a rule of the UICC system of cutaneous malignant melanoma and non-melanoma skin cancer. Assignment of pT stage for melanoma requires accurate measurement of pathological findings. On the other hand, T classification of SCC is decided only by measurement of size. We introduced the UICC TNM staging systems and compared the 5-year survival rate of our cases with the statistical data of the Japanese Society for Skin Cancer.     

The prognostic significance of lymphocytic infiltration in malignant melanoma of the choroid

Lymphocytic and plasmocytic infiltration surrounding a malignant tumor probably represents an immunologic response of the host directed against the neoplasm. It has been documented that lymphocytic infiltration has a favorable effect on prognosis in a number of human tumor systems, including cutaneous melanoma. In the present study, 309 consecutive cases of choroidal melanoma were examined for cellular infiltration, and these data were correlated with other histologic parameters and with prognosis. A intense cellular infiltration was found in 15 tumors (4.9%) and a moderate infiltration in 37 (12.0%). Tumors with cellular infiltration were significantly larger and more vascularized than the remaining tumors, which may be related to the accessibility of the immune system to the tumor. There was a higher percentage of poorly differentiated tumors among the tumors with cellular infiltration. However, it does not appear the cellular infiltration favorably influences the prognosis of choroidal melanoma. The 5-year survival rates of patients with like cell types did not depend upon the degree of cellular infiltration demonstrated by the primary tumor. Although choroidal melanomas are capable of inciting an immune response, this response is apparently ineffective in preventing metastatic spread.     

Incidence and thickness of primary tumours and survival of patients with cutaneous malignant melanoma in relation to socioeconomic status

OBJECTIVE: To study incidence of and survival from cutaneous malignant melanoma in relation to socioeconomic status. DESIGN: Application of Carstairs deprivation score to all malignant melanoma patients diagnosed in a geographically defined area over a 15 year period. SETTING: West of Scotland (area population 2,716,900). SUBJECTS: 3142 patients first diagnosed with malignant melanoma in the period 1979-93. INTERVENTIONS: Surgical excision of primary malignant melanoma with additional treatment as appropriate and follow up until December 1994. MAIN OUTCOME MEASURES: Malignant melanoma incidence, primary tumour thickness and five year survival by socioeconomic status. RESULTS: From 1979 to 1993, the age standardised incidence rate for cutaneous malignant melanoma was 9.1/100,000 for the most affluent men and 2.4/100,000 for the least affluent men and 16.1/100,000 and 5.0/100,000 respectively for most and least affluent women (P < 0.001 for trend in both). The incidence increased steadily over time in both sexes in all socioeconomic groups. Good prognosis tumours ( < 1.5 mm thick) were most common in the most affluent men and women, and over the study period the proportion of such tumours increased most in the intermediate affluence group (both sexes) and in the least affluent women. Five year disease free survival from melanoma for the sexes combined was 81% for most affluent, 77% for intermediate, and 73% for least affluent groups. Even after adjustment for known prognostic factors of tumour thickness, ulceration, age, and body site of primary melanoma, the more affluent the group, the better the survival. CONCLUSION: Although the incidence of cutaneous malignant melanoma is higher among more affluent people, the prognosis is better in this group than for less affluent individuals. Early diagnosis campaigns should be targeted particularly to less affluent men and primary prevention campaigns should emphasise the greater risk in more affluent women.     

Malignant melanoma of the vagina in pregnancy: description of a clinical case

Vaginal melanoma in pregnancy is a rare but extremely malignant tumour for which the prognosis is worsened by the fact that pregnancy increases the secretion of Melanocyte-Stimulating Hormone (MSH). The clinical case is described of a malignant vaginal melanoma in a 27 year-old woman in her 38th week of gestation, who was referred for slight vaginal bleeding. Clinical examination revealed a 3 cm pedunculate tumour on the anterior wall of the vagina. Vaginal cytology suggested a melanoma and instrumental examination failed to reveal any lymph node involvement. The vaginal tumour was removed during a caesarean section and subsequent histological examination identified it as a Breslow Stage II malignant melanoma. A 24-month follow-up showed the patient to have been completely cured.     

Cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation

The aim of this study was to delineate clinical features and prognosis of cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation, and to determine methods for managing the disease. A retrospective study of seven patients is presented. A further 27 cases from the Japanese literature were reviewed retrospectively with regard to method of treatment and prognosis. In 11 of 18 patients in whom staging was known the tumour was stage V, representing advanced disease. In seven of 34 cases curative operation was performed; only two patients survived for > 3 years. This poor outcome was due largely to delayed diagnosis of cancer of the gallbladder. Prophylactic cholecystectomy is recommended in patients with this anomalous junction without bile duct dilatation or a malignant lesion in the gallbladder, because of the high incidence of cancer of the biliary tract.     

The inhibitory effect of glucagon-like peptide-1 (7-36)amide on antral motility is antagonized by its N-terminally truncated primary metabolite GLP-1 (9-36)amide

BACKGROUND: The frequency of plantar melanoma varies widely in different population groups. The plantar surface is an infrequent site in white persons but is common in the black population. The effect of ethnicity on melanoma of the plantar surface has not previously been well defined. The aim of this study was to analyze the results of a standard protocol of treatment of melanoma of the sole in 3 homogeneous population groups treated during a 15-year period at a university referral hospital. METHODS: A retrospective analysis of 1403 consecutive patients with melanoma treated between 1977 and 1991 was performed. Eighty-five patients (35 black, 25 white, and 16 of mixed ancestry) had primary cutaneous melanoma involving the sole of the foot. RESULTS: Acral lentiginous melanoma was the most common histogenetic type and occurred in 49 patients. Significantly more black patients (20 of 35) had metastatic disease compared with white patients or groups with mixed ancestry (P < .05). The Breslow depth was significantly more advanced in black patients (7.1 mm) with stage I disease than in white patients (3.3 mm) or those of mixed ancestry (3.6 mm) (P < .05). The 5-year survival rate was 60% for white patients, 26% for black patients, and 24% for those of mixed ancestry. CONCLUSIONS: Black patients were seen more frequently with advanced local disease, and nearly half had disseminated disease. Those of mixed ancestry had a histogenetic type resembling that of black patients, but the Breslow depth of penetration was similar to that of white patients. Education programs to heighten awareness of both patient and physician are required to enable earlier diagnosis and improve outcome.     

Isolated middle lobe atelectasis: aetiology, pathogenesis, and treatment of the so-called middle lobe syndrome

Isolated atelectasis of the middle lobe has been known for many years as the "middle lobe syndrome". Several clinical studies have shown that it may bae caused by malignant tumours. A 10-year study of 135 patients with isolated middle lobe atelectasis is presented. Fifty-eight patients (43%) had malignant tumours. Of 38 who had a thoracotomy, lung resection was possible in 25. In 20 patients regional or systemic dissemination of the tumour had been diagnosed before operation. Seventy-seven patients had benign diseases, of which 74 were non-specific infections. Bronchography was performed in 46 of these cases, and all had abnormal findings in the middle lobe, eight revealing definite bronchiectasis. In three cases tuberculosis was found. In 16 cases the benign diagnosis was established at thoracotomy. Only three patients out of 58 with malignant tumours lived more than five years. Atelectasis of the middle lobe is always a sign of potential malignancy especially in patients with a previously normal chest radiograph.     

Metastatic melanoma of unknown primary origin shows prognostic similarities to regional metastatic melanoma: recommendations for initial staging examinations

BACKGROUND: Metastatic melanoma of unknown primary origin accounts for approximately 2-6% of all melanoma cases. The prognostic significance of this diagnosis is still controversial. METHODS: Of 3258 patients with malignant melanoma recorded during the period 1976-1996, 2.3% had metastases of unknown primary origin. Anatomic distribution, clinical stage, and survival probabilities were evaluated. RESULTS: Thirty patients were classified as having cutaneous or subcutaneous in-transit metastases, and they showed a 5-year survival rate of 83%. Thirty-seven patients were classified as having lymph node metastasis, and their 5-year survival rate was 50%. Disseminated disease was diagnosed in only 8 patients, who had a median survival of 6 months. Comparison of survival probabilities for patients with in-transit metastases and unknown primary tumors with the probabilities for those with cutaneous primary tumors revealed a significant advantage for the former group. No significant differences were found for patients with lymph node metastasis when those with unknown primary tumors were compared with those who had cutaneous melanomas with regional lymph node metastasis. CONCLUSIONS: The clinical disease course of patients with metastatic melanoma of unknown primary origin is similar to that of patients with primary cutaneous melanoma when the same clinical stages of the disease are compared. Based on the assumption that the majority of regional metastases develop from completely regressed primary cutaneous melanoma, recommendations for initial staging examinations in patients with unknown primary tumors are given in this article.     

Treatment of malignant melanoma (clinical stages I and II) (author's transl)

The uncorrected cumulative five-year survival rate ("actuarial method") among 195 patients with infiltrative malignant melanoma of the skin was 58% (160 cases) in clinical stage I, 26% (35 cases) in clinical stage II. In addition to clinical staging, microstaging - i.e. the histologically determined depth of invasion of the primary tumour - is of great prognostic significance. In microstages 2 and 3 with the largest vertical tumour diameter below 0.76 mm, five-year survival rate was 100% while in microstage 3 with greater vertical tumour diameter it was 66% in microstage 4 55% and microstage 5 31%. Results of treatment can be reliably interpreted only if they are divided according to microstage. Propylactic dissection of the regional lymph-nodes (dissection in clinical stage I) need not be undertaken in microstages 2 and 3 with vertical tumours diameter below 0.76 mm. Whether prophylactic dissection was done in one or two sessions has apprarently no significant influence on survival rate. A single X-radiation dose to the primary tumour of 4 000 -6000 R immediately before excision of the tumour did not significantly increase the results. The results were particularly bad when the primary tumour was removed after inadequate manipulation.     

Prognosis in pT3b infiltrating tumors of the bladder treated by adjuvant chemotherapy

OBJECTIVE: To evaluate the prognosis of stage pT3bM0 invasive urothelial bladder tumours treated by cystectomy alone or combined with adjuvant chemotherapy according to the MVAC protocol (methotrexate, vinblastine, adriamycin and cisplatin). MATERIAL AND METHODS: From 1987 to 1996, 90 patients with stage pT3M0 urothelial bladder tumours were treated with isolated cystectomy (n = 69) or followed by MVAC chemotherapy (n = 21). Lymph node stage was N0 (n = 55), N+ (n = 29) or Nx (n = 6). Essentially selected because of their good general status, patients treated with chemotherapy had a lymph node stage N0 (n = 7) or N+ (n = 14). Chemotherapy had to be suspended in 2 cases and with a fatal outcome during treatment in 4 cases, due to tumour progression, surgical complication or bone marrow aplasia. RESULTS: 65 deaths have occurred with a follow-up of 2 to 120 months (m = 15), including 2 postoperative deaths, 39 cancer deaths and 14 intercurrent deaths. The 1-year, 2-year and 5-year actuarial survival rates were 70%, 48% and 19% for stage N0 and 54%, 25% and 3% for stage N+, respectively, with corresponding median survivals of 20 and 12 months (p < 0.005). The recurrence rate increased from 40% at stage N0 to 62% at stage N+ (p = 0.05), and the corresponding recurrence-free survivals were 16 months and 7 months (p < 0.02). The median survival without chemotherapy ranged from 11 months at stage N+ to 20 months at stage N0 and, with chemotherapy, from 19 months at stage N+ to 67 months at stage N0. The median recurrence-free survival with and without chemotherapy, was 43 months and 17 months at stage N0 and 12 months and 7 months at stage N+. CONCLUSION: The prognosis after cystectomy for stage pT3b bladder cancer is severe, especially in the presence of lymph node involvement. Adjuvant chemotherapy according to the MVAC protocol tends to improve survival, especially recurrence-free survival, and appears beneficial at stage N0. However, the value of this adjuvant treatment, which is associated with a high specific morbidity appears to be more relative at stage N+.     

Primary immune response to Helix pomatia haemocyanin in malignant melanoma. Relationship between 19S and 7S antibody response and in vitro lymphocyte transformation

The primary immune response to Helix pamatia haemocyanin (HPH) was investigated in sixty-one patients with various clinical signs of malignant melanoma and compared to that of controls. Anti-HPH antibody response was only found abnormal in patients with widespread disease and visceral metastases, apparent from decreased 7S and increased 19S antibody levels. In vitro HPH-induced lymphocyte transformation, in contrast, was not only decreased in this late stage, but also in part of the patients in the beginning of the disease and was then correlated with subsequent tumour recurrence within 6 months. Generally, patients with positive lymphocyte transformation showed significantly higher 7S anti-HPH titres (mean 3-3 +/- 2-4 than patients without (1-7 +/- 1-6). In contrast to the lymphocyte transformation reaction, anti-HPH antibody response was not correlated with subsequent tumour recurrence. The same phenomenon of decreased 7S and increased 19S antibody response as in the melanoma patients with far advanced disease was observed to a less extent in controls with ageing. Anamnestic antibody responses to diphtheria and tetanus toxoid and serum IgG and IgA levels were found normal. Elevated serum IgM levels were more frequently observed in patients with localized (19/31) and disseminated disease (11/29) than in controls (2/31). These results suggest that melanoma patients develop impaired T-lymphocyte functions in final stages with visceral metastases. A previous study showed that minor defects in lymphocyte function in an early stage as measured by HPH-induced lymphocyte transformation have predictive value for subsequent tumour recurrence.     

Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review

OBJECTIVE: Compare 5-year melanoma survival rates to rates in medical literature. DESIGN: Retrospective. SETTING: Hospital in Tijuana, Mexico. PATIENTS: White adult patients (N = 153) with superficial spreading and nodular melanoma, aged 25-72 years. INTERVENTION: Gerson's diet therapy: lactovegetarian; low sodium, fat and (temporarily) protein; high potassium, fluid, and nutrients (hourly raw vegetable/fruit juices). Metabolism increased by thyroid; calorie supply limited to 2600-3200 calories per day. Coffee enemas as needed for pain and appetite. MAIN OUTCOME MEASURE: 5-year survival rates by stage at admission. RESULTS: Of 14 patients with stages I and II (localized) melanoma, 100% survived for 5 years, compared with 79% of 15,798 reported by Balch. Of 17 with stage IIIA (regionally metastasized) melanoma, 82% were alive at 5 years, in contrast to 39% of 103 from Fachklinik Hornheide. Of 33 with combined stages IIIA + IIIB (regionally metastasized) melanoma, 70% lived 5 years, compared with 41% of 134 from Fachklinik Hornheide. We propose a new stage division: IVA (distant lymph, skin, and subcutaneous tissue metastases), and IVB (visceral metastases). Of 18 with stage IVA melanoma, 39% were alive at 5 years, compared with only 6% of 194 from the Eastern Cooperative Oncology Group. Survival impact was not assessed for stage IVB. Male and female survival rates were identical for stages I-IIIB, but stage IVA women had a strong survival advantage. CONCLUSIONS: The 5-year survival rates reported here are considerably higher than those reported elsewhere. Stage IIIA/B males had exceptionally high survival rates compared with those reported by other centers.     

Intratumoral oxygen tension in metastatic melanoma

Tumour hypoxia can lead to a decrease in the biological effectiveness of radiation and alkylating agents. Few data are available on oxygen tension (PO2) in melanoma. In 20 patients with past history of melanoma, PO2 was evaluated in normal tissues and suspected metastatic lesions (nodes and skin metastases). Oxygen tension was measured using a needle probe technique (KIMOC-6650 histograph, Eppendorf, Germany), the day before the surgical removal of the suspected metastatic lesion. Histological confirmation of the malignant origin of the removed lesion was obtained in 18 cases. In two cases invasion by the known melanoma was not seen histologically. The median PO2 for normal tissues was 40.5 mmHg. For tumours, the median PO2 was 11.6 mmHg, and it was 17.1 mmHg in nodes and 6.7 mmHg in skin metastases. Very low values (< 2 mmHg) accounted for 20% of the recorded values in nodes and 15% in skin metastases. When analysed according to the node size (< or > or = 3 cm in diameter), the median PO2 was 10.4 mmHg in large nodes (six patients) and 53.3 mmHg in small nodes (six patients). For the two non-tumoral lesions, the median PO2 values were 20.9 and 25.1 mmHg, with no values below 10 mmHg. Thus a decrease in PO2 values, probably corresponding to tumour hypoxia, was found in most of the metastatic tumours when compared with normal tissues. The prognostic value of these PO2 measurements in melanoma remains to be demonstrated in the tumour response to radiotherapy or alkylating agents. However, tumour hypoxia can already be investigated as a target for new treatment modalities in metastatic melanoma.