Cutaneous malignant melanoma

• Main Author: Wilson, Kenneth Scott
• Published: University of Edinburgh 1994
• Subjects: 610.21
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.663917

Epidemiology, clinical presentation, natural history, pathological features and treatment of cutaneous malignant melanoma have been studied in the British Columbia Cancer Agency [BCCA]. A retrospective review of 891 patients registered between 1972 and 1981 is presented. Age standardised incidence rates have increased significantly. Predominant primary sites were trunk for males and lower limb for females. Dominant growth patterns were superficial spreading [65%], nodular [25%], lentigo maligna [5%] and acral-lentiginous melanoma [2%]. Median primary tumor depth at presentation were 1.45mm for males and 1.10mm for females. No T 1 tumors were staged beyond the local area. Fifteen year survival was 55.5% for males and 70.3% for females. Multivariate analyses of prognostic factors in 556 clinical stage 1 patients showed that micrometer depth, pathological ulceration, primary site and type of initial surgery were principal prognostic factors. Elective lymph node dissections [ELND] were undertaken in 232 patients. Nodes examined after ELND were positive pathologically in 36 [16%] patients. Survival after ELND was compared with a concurrent group of patients not undergoing ELND and with other series. Multivariate analysis did not show ELND to be of independent significance. Survival after therapeutic LND was comparable with previous series. Adjuvant therapy with BCG and levamisole for 3 years was investigated in 76 patients from British Columbia as part of a National Cancer Institute of Canada Clinical Trials Group Study involving 543 patients. All patients were clinically disease-free after standard surgery for high risk primary or recurrent regional melanoma. Patients who received Levamisole alone experienced 30% fewer deaths than no immunotherapy control patients. Survival was worst in older patients in the control group and levamisole appeared to abolish the adverse prognostic significance of age.