ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01120.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

When scanning electron microscopy (SEM) was applied to the study of intradermal nevi, interesting tridimensional features were recognized. The free surface of the lesions showed ruffled keratinized cells. “Normal” hairs as well as “corkscrew” hairs emerged from the follicular openings. Nevus cells were either round or elongated and surrounded by connective tissue

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01121.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

We have attempted to review virtually all forms of cutaneous and mucocutaneous melanomas. Superficial spreading, lentigo maligna and nodular melanomas have been more thoroughly investigated and documented in previous studies. Lentigo maligna melanoma appears to have a longer duration and better prognosis than SSM or NM. The overall prognosis probably correlates better with the anatomic level and thickness of invasion than with type (Clark et al. 1975, Breslow 1970, 1975). It appears that certain pitfalls exist in either method of assessing prognosis, and it is recommended that both methods be applied in evaluating a malignant melanocytic lesion when feasible. With regard toin situmelanoma or Level I melanoma, it is our experience that such lesions can achieve a 100% cure rate when completely excised. Hence, we prefer to call such lesions severely atypical melanocytic hyperplasia, and thus avoid labeling these patients with a malignant diagnosis. The most difficult histologic challenge in diagnosing a lesion of malignant melanoma is the Spitz nevus. The pathologist should never be biased by the age of the patient, for a serious mistake can arise. We have seen a case of nodular melanoma in a 13‐year‐old girl diagnosed as Spitz nevus only to be followed by a lymph node metastasis years later. Other examples of histologic differential diagnoses of malignant melanomas include, for example, halo nevus, soft tissue sarcoma, squamous cell carcinoma with spindle cell proliferation, Paget's disease of metastatic carcinoma, (for example, from the breast). Therefore, the approach to the diagnosis of malignant melanoma necessitates an evaluation of both clinical and pathological features. Histologic study must encompass both the pattern of growth and cellular cytologic detail for successful interpretat

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01122.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Proteolytic activities were measured in extracts of human skin melanoma, lymphatic metastasis and in nonmalignant naevi by using various proteinase substrates as well as plasminogen activator assay. pH‐optima for hydrolysis of various proteinase substrates by these tumors were found to be essentially the same as in healthy human skin. Melanoma extracts were found to especially readily hydrolyze N‐α‐benzoyl‐DL‐arginine β‐naphthylamine (BANA) at pH 5.8 in the presence of 1 mmol/1 dithiothreitol and EDTA (cathepsin B1‐like enzyme) as well as histones and p‐tosyl‐L‐arginine methyl ester (TAME) at pH 7.5, and showed increased capacity to activate plasminogen when compared to nonmalignant naevus. The possible role of proteinases in malignant

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01123.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The interaction between immune system and growing tumor can be expressed differently at different stages of the disease. This presentation covers three facets of these reactions in melanoma patients. A.The Primary Tumor. Time‐lapse cinematography, with an analysis of lymphocyte movement demonstrated positive and negative chemotaxis against tumor tissues which correlated with their histological presence or absence within the primary tumor. B.The Regional Lymph Nodes. Histological examination of regional lymph nodes showed an increase in germinal center activity and B cell number, with a decrease in sinus histiocytosis and monocyte count as the tumor progressively invaded the node. This correlated with the elution studies, wherein the anti‐membrane antibody decreased and the anti‐cytoplasmic antibody increased during the same period of progression. C.Humoral Immunity and Metastasis. Clinical metastasis heralded the decrease of anti‐membrane antibodies with a rise in anti‐immunoglobulins, especially anti‐idotypic antibodies and immune complexes containing tumor‐directed antibody and either antigen or anti‐immunoglobulin. This triad of anti‐immunoglobulin, immune complexes and anergy as seen in other diseases with persistent antigenic stimulation, results in abnormal regulatio

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01124.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The incidence of metastasis in cutaneous melanoma is proportional to maximal tumor thickness. The relationship is linear for extremity melanoma but not for tumors from all body sites, probably due to intrinsic differences in tumors from different sites. The level of invasion of the tumor is an indirect measure of tumor thickness and is not as accurate in predicting metastases because of the marked variation in thickness within each level. The implications of these observations for the treatment of melanoma are discussed.

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01125.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Malignant melanoma is a disease characterized by clinical evidence of host defense, possibly immunologically mediated. It is a disease which tends to be refractory to both radiotherapy and chemotherapy. Immunotherapy has been used in three phases of the disease. 1. Intralesional immunotherapy with a nonspecific immune adjuvant in patients with local intradermal or soft tissue recurrence. This treatment produces approximately 15% regression of both injected and uninjected lesions, and about 60% regression of injected lesions only. Both clinical and laboratory evidence suggests that this regression is immunologically mediated. 2. Patients with surgical removal of all clinically demonstrable tumor, either primary disease alone or regional node recurrence, active nonspecific, and specific, immunotherapy has been used in an adjuvant setting. There is considerable controversy about the benefits accruing to such immunotherapy, but most large scale prospective and randomized studies have suggested that if benefit does result it is modest in degree and probably cannot be measured in terms of increase in cure rate. 3. Immunotherapy has also been used as a nonspecific active adjuvant to single drug or polychemotherapy in patients with disseminated melanoma. Whereas complete response rate may be slightly increased by this maneuver there is no convincing evidence that immunotherapy markedly increases the total objective response rate to polychemotherapy, and survival is only marginally superior when immunotherapy is added to chemotherapy in this setting. Further studies need to be done with active specific immunotherapy with tumor cell membrane extracts; as an adjuvant in patients with minimal body burden of tumor cells; and to study the inaction between chemotherapy and immunotherapy in this disease. Furthermore, studies of chemically defined fractions of either bacterial cell wall or tumor cell extracts must be evaluated both in terms of their ability to augment cell mediated immune responses in the melanoma patient, and also in terms of their ability to induce objective benefit for the patient. The possible use of immunotherapy in patients with primary melanoma has been briefly explored but needs further study. Possible additive effects with radiotherapy and immunotherapy should also be looked at in this disease utilizing high dose fractions and other new forms of radiotherapeutic technique.

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01126.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Traditionally, melanoma has been considered by surgeons to be a highly lethal malignancy, always requiring a radical surgical approach for optimal chance of cure. Yet melanoma patients who are now being referred for treatment frequently have small early lesions, and surgeons should develop a flexible attitude about management, limiting the size of their excisions and deferring node dissections in many early cases. An aggressive, radical approach remains appropriate for large lesions, progressively enlarging nodes and locally recurrent but not disseminated disease.

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01127.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01128.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0303-6987    

DOI:10.1111/j.1600-0560.1979.tb01129.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY