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  • 1
    Electronic Resource
    Electronic Resource
    Letter to the Editor (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 514-514 
    Details
    ISSN: 1534-4681
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0514-5
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  • 2
    Electronic Resource
    Electronic Resource
    Polyvalent Melanoma Vaccine Improves Survival of Patients with Metastatic Melanoma (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 690 (1993), S. 0 
    Details
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1749-6632.1993.tb44002.x
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  • 3
    Electronic Resource
    Electronic Resource
    Melanoma (1981)
    Oxford, UK : Blackwell Publishing Ltd
    International journal of dermatology 20 (1981), S. 0 
    Details
    ISSN: 1365-4632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: : Three instances of depigmentation occurring in children with congenital large nevocytic nevi are reported. Serologic studies for tumor-associated antigens to melanoma were performed by indirect immunofluorescence and complement fixation on these patients and others with benign melanocytic disorders. Positive reactivity in several children was observed. The small numbers studied and lack of uniformity of other testing methods leave open the question of relevanc of such reactivity to malignant conversion or protection in congenital nevi.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-4362.1981.tb00823.x
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  • 4
    Electronic Resource
    Electronic Resource
    Metastasis of primary melanoma to two separate lymph node basins: Prognostic significance (1997)
    Springer
    Annals of surgical oncology 4 (1997), S. 13-18 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Prognosis ; Lymph nodes ; Lymphadenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background and Methods: Depending on the location of the primary lesion, melanoma patients may develop metastases in more than one regional lymph node basin. To determine whether this is prognostically significant, we reviewed our experience with melanoma patients who had undergone regional lymphadenectomy (RLND) in two separate basins. Results: Of 3,603 patients who underwent RLND between April 1971 and January 1993, 406 underwent procedures in two separate basins; of these, 120 (30%) had metastases in both basins and 124 (30%) had metastases in one basin. When calculated from the first positive RLND, 1-year, 3-year, and 5-year survival rates were 82%, 48%, and 33%, respectively, for patients with dual-basin involvement and 88%, 59%, and 48%, respectively, for patients with single-basin involvement (p=0.0173). Median survival from the first positive RLND was 33.5 months for dual-basin involvement and 56.6 months for single-basin involvement. Univariate analysis demonstrated that Breslow thickness of the primary melanoma, clinical status of the regional lymph nodes, number of positive RLNDs, and tumor burden (total number of positive lymph nodes) were significant indicators of survival. The patient's age and gender, the anatomic location and Clark level of the primary melanoma, the disease-free interval before regional metastasis, and the site and timing of RLNDs were not significant by univariate analysis. Multivariate analysis demonstrated significance for Breslow thickness, number of positive RLNDs, and tumor burden. Conclusions: The survival rate of melanoma patients with regional metastases in two lymph node basins is lower than that of patients with an equal tumor burden confined to a single basin. This suggests that primary melanomas metastasizing to more than one lymph node basin may have a higher metastatic potential, or that dual-basin involvement may increase the risk of systemic spread. We advocate lymphatic mapping, sentinel node biopsy, and selective lymphadenectomy as a cost-effective technique with little morbidity to identify and manage occult metastases in patients who have two lymph basins at risk.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02316805
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  • 5
    Electronic Resource
    Electronic Resource
    Lymph Node Biopsy Does Not Impair Survival After Therapeutic Dissection for Palpable Melanoma Metastases (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 139-143 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Lymph node ; Dissection ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To determine the effects of disrupting a nodal basin in patients with American Joint Committee on Cancer stage III melanoma with clinically palpable lymph nodes, we studied patients who underwent therapeutic lymph node dissection after excisional lymph node biopsy, after fine-needle aspiration (FNA) biopsy, or without a preoperative biopsy. Methods: We performed a retrospective review of our patients with American Joint Committee on Cancer stage III melanoma who were treated between January 1972 and June 1995, using data acquired from our 8200-patient database. The study group included 670 patients with melanoma, with known primary tumors, who underwent therapeutic lymph node dissection for palpable nodal metastases diagnosed by open biopsy (227 patients), by FNA (66 patients), or by clinical observation without biopsy (377 patients). Regional node recurrence, 5-year disease-free survival, and overall survival rates were calculated. Results: The same-basin regional node recurrence rates were similar for the three groups (open biopsy, 4.6%; FNA, 3.2%; no biopsy, 4.6%; P = .14). The 5-year disease-free survival rates were 36.8% for the open-biopsy group, 29.6% for the FNA group, and 28.9% for the no-biopsy group (P = .08); corresponding 5-year overall survival rates were 40.6%, 43.9%, and 36.1%, respectively (P = .18). Multivariate analysis failed to identify preoperative biopsy as a significant risk factor. Matched-pair analysis using age, gender, primary tumor site, Breslow thickness, and tumor burden showed no differences in the 5-year disease-free survival rates (33% for the open-biopsy group vs. 27% for the FNA and no-biopsy groups, P = .42) and the 5-year overall survival rates (41% vs. 35%, P = .32). Conclusions: For patients with melanoma with palpable regional adenopathy, histological confirmation of clinical suspicion with either FNA or excisional lymph node biopsy does not adversely affect survival or recurrence rates.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0139-8
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  • 6
    Electronic Resource
    Electronic Resource
    Long-Term Survival After Complete Resection of Melanoma Metastatic to the Adrenal Gland (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 633-639 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Adrenal ; Metastases ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Survival of patients with American Joint Committee on Cancer stage IV melanoma is generally poor, although there are occasional long-term survivors who have undergone surgical resection of a limited number of metastases. In the study, we examined the outcome of patients with adrenal gland metastases. Methods: Eighty-three patients with adrenal metastases were identified from our computerized melanoma database of 8250 patients. Univariate and multivariate analyses for overall survival differences were performed by using proportional hazards modeling. Results: Median survival for the 83 patients was 9.3 months (1–67 months). Of the 27 patients who underwent surgical exploration, 18 (66%) were rendered clinically free of disease by adrenalectomy alone (12 cases) or by adrenalectomy and resection of additional disease (6 cases). Nine patients underwent palliative adrenal resection. Median survival was 25.7 months after complete resection compared with 9.2 months after palliative resection (P = .02). Conclusions: Patients with adrenal metastases from melanoma, either isolated or with a limited number of additional metastases, may benefit from surgical resection if all visible disease can be removed. Patients with unresectable extra-adrenal disease achieve no survival benefit from adrenalectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0633-z
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  • 7
    Electronic Resource
    Electronic Resource
    Increased Incidence of Second Primary Melanoma in Patients With a Previous Cutaneous Melanoma (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 705-711 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Multiple primary sites ; Incidence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Patients with cutaneous melanoma reportedly have an increased risk of developing second primary melanoma; however, this increased risk has not been well characterized with respect to age and time from first melanoma. We hypothesized that, as a result of temporal variations in environmental exposure, genetic susceptibility, and impaired immune competence, the incidence of second primary melanoma varies significantly with respect to age and time. Methods: A review of our prospective melanoma data base, containing records for 8928 patients, was undertaken to identify patients with American Joint Committee on Cancer stage I and II cutaneous melanoma, who were treated from 1971 to 1998. Results: Second primary melanoma was identified in 113 (3.4%) of 3310 patients with American Joint Committee on Cancer stage I and II cutaneous melanoma. In 11 patients (0.3%), the second melanoma was identified within 2 months of the initial tumor; the remaining 102 patients had a metachronous lesion. The incidence rate of second primary melanoma was 325 per 100,000. The standardized incidence ratio, defined as the ratio of the number of observed second melanomas to the number of expected melanoma cases, was 25.6. The 5- and 10-year risk of developing a second melanoma was 2.8% and 3.6%, respectively. Both the annual risk of developing a second melanoma and the standardized incidence ratio were elevated in younger patients (ages 15–39 years) and in older patients (ages 65–79 years). Conclusions: Patients with cutaneous melanoma are at very high risk for development of second primary melanoma. This risk approximates 0.5% per year for the first 5 years of follow-up. Patients aged 15–39 and patients aged 65–79 have a particularly high incidence of second melanoma, suggesting different causes for the development of second primaries. All patients with melanoma should undergo careful surveillance for second melanomas in addition to routine screening for recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0705-0
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  • 8
    Electronic Resource
    Electronic Resource
    Efficacy of Lymphatic Mapping, Sentinel Lymphadenectomy, and Selective Complete Lymph Node Dissection as a Therapeutic Procedure for Early-Stage Melanoma (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 442-449 
    Details
    ISSN: 1534-4681
    Keywords: Malignant melanoma ; Lymph node dissection ; Sentinel lymph node ; Matchedpair analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection (LM/SL/SCLND) is an increasingly popular alternative to elective lymphadenectomy (ELND) for patients with early-stage melanoma. Although several reports have demonstrated the accuracy of the LM/SL technique, there are no data on its therapeutic value. Methods: We performed a matched-pair statistical analysis of 534 patients with clinical stage I melanoma; one half of the patients were treated with LM/SL and the other half were treated with ELND. Patients in the two treatment groups were matched for age (54% were ≤50 years of age), gender (63% were male patients), site of the primary melanoma (49% were on the extremities, 36% on the trunk, and 15% on the head and neck), and thickness of the primary melanoma (7% were 〈0.75 mm, 42% between 0.75 and 1.5 mm, 43% between 1.51 and 4.0 mm, and 8% 〉4 mm). Patients in the LM/SL group underwent complete regional lymphadenectomy (SCLND) only if the LM/SL specimen contained metastatic melanoma. Results: The overall incidences of nodal metastases were no different (P = .18) between LM/SL (15.7%) and ELND (12%) groups, but the incidence of occult nodal disease was significantly (P = .025) higher among patients with intermediate-thickness (1.51–4.0-mm) primary tumors who underwent LM/SL (23.7%) instead of ELND (12.2%). Survival data were compared by the log-rank score test. LM/SL/SCLND and ELND resulted in equivalent 5-year rates of disease-free survival (79 ± 3.3% and 84 ± 2.2%, respectively; P = .25) and overall survival (88 ± 3.0% and 86 ± 2.1%, respectively; P = .98). The LM/SL and ELND groups also exhibited similar incidences of same-basin recurrences (4.8% vs. 2.1%, P = .10, respectively) and in-transit metastases (2.6% vs. 3.8%, P = .48) after tumor-negative dissections. Patients who underwent ELND showed a higher incidence of distant recurrences (8.9% vs. 4.0%, P = .03), but this may be related to the longer follow-up period for these patients (median, 169 months), compared with the LM/SL-treated patients (45 months). Among patients with tumor-positive nodal dissections, the 5-year overall survival rates were higher, and approached significance (P = .077) for patients treated by LM/SL/SCLND (64 ± 12%) compared with ELND (45 ± 10%). Conclusions: These findings suggest that LM/SL/SCLND is therapeutically equivalent to ELND but may be more effective for identifying nodal metastases in patients with intermediate-thickness primary tumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0442-4
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  • 9
    Electronic Resource
    Electronic Resource
    TA90-IC, A New Marker for Advanced Colon Cancer (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 352-356 
    Details
    ISSN: 1534-4681
    Keywords: Carcinoembryonic antigen ; Colon cancer ; TA90 circulating immune complexes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Although carcinoembryonic antigen (CEA) is the most frequently used marker for colon cancer, it is elevated in only 70% of patients with advanced disease and in even fewer patients with earlier stages of disease. We previously identified a 90-kDa glycoprotein, TA90, which is present in serum in the form of circulating immune complexes. TA90 is found in a variety of solid neoplasms but rarely in healthy controls (3.2%). We hypothesized that this new tumor-associated antigen may be a useful marker for colon cancer. Methods: Serum samples from 59 patients with known colon adenocarcinoma were analyzed for the presence of CEA and TA90. Fifty-one (86%) patients had distant metastases; the remaining patients had clinically localized primary colon cancer. A murine monoclonal antibody-based enzyme-linked immunosorbent assay was used to measure concentrations of TA90-specific circulating immune complexes (TA90-IC). A positive value was defined as an optical density of more than 0.410 at 405 nm. Forty-seven (80%) of the 59 patients had serum samples for TA90 and CEA drawn at the same time. Results: TA90-IC concentrations were elevated more frequently than CEA concentrations (82.9% vs. 70.2%; P 5.134). The combination of both markers identified more patients with colon carcinoma than did either marker alone (93.6%; P,.001). Conclusions: Concomitant use of TA90-IC and CEA identified 93.6% of patients with advanced colon cancer. The role of TA90-IC in screening and monitoring progression of earlier disease deserves further investigation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0352-y
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  • 10
    Electronic Resource
    Electronic Resource
    Can Elective Lymph Node Dissection Decrease the Frequency and Mortality Rate of Late Melanoma Recurrences? (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 114-119 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Recurrence ; Disease-free interval ; Lymph node dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Although more than 90% of the morbidity and mortality from localized cutaneous melanoma occurs in the first decade after initial surgical treatment, melanoma can recur after a 10-year disease-free interval (DFI) with fatal consequences. We reviewed our melanoma data base of more than 8500 prospectively acquired patients to identify clinicopathological factors that affect the type, rate of occurrence, and outcome of disease recurring 10 years or more after surgical treatment of primary cutaneous melanoma. Methods: From 1971 to 1997, 1907 melanoma patients treated at our cancer center reached or presented with a DFI of 10 years or more after surgical treatment of clinically localized melanoma. Of these, 217 (11%) patients had recurrences (mean DFI, 182 months). The sites of recurrence were local/in-transit in 26 (12%) patients, regional lymph nodes in 101 (47%) patients, and distant sites in 90 (41%) patients. Results: Univariate and multivariate analysis, using patient age and sex, type of initial treatment, and the site, Breslow thickness, and Clark level of the initial tumor, showed that the type of treatment for the primary tumor was a significant (P = .0005) prognostic factor in the development of late nodal recurrence. Of the 217 patients who had recurrences, 172 (79%) had undergone wide local excision for their primary melanoma, and 45 (21%) had undergone wide local excision plus elective lymph node dissection (ELND). The rates of nodal recurrence were 53% (92 of 172) and 20% (9 of 45), respectively, a significant (P = .0001) difference. When all patients with a DFI of 10 years or more were stratified by type of initial treatment, the ELND group demonstrated a significant improvement in disease-free survival and overall survival. Conclusions: The risk of late-recurring nodal disease increases and the chance of long-term survival decreases when wide local excision is performed without ELND. With the advent of sentinel lymphadenectomy, ELND can be selectively performed only for those nodal basins with occult tumor cells, thereby decreasing operative morbidity but allowing identification and early removal of nodal micrometastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0114-x
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