Online prediction tools for melanoma survival: A comparison.

BACKGROUND: Breslow thickness, patient age and ulceration are the three most valuable clinical and pathological predictors of melanoma survival. A readily available reliable online tool that accurately considers these and other predictors could be valuable for clinicians managing melanoma patients. OBJECTIVE: To compare online melanoma survival prediction tools that request user input on clinical and pathological features. METHODS: Search engines were used to identify available predictive nomograms. For each, clinical and pathological predictors were compared. RESULTS: Three tools were identified. The American Joint Committee on Cancer tool inappropriately rated thin tumours as higher risk than intermediate tumours. The University of Louisville tool was found to have six shortcomings: a requirement for sentinel node biopsy, unavailable input of thin melanoma or patients over 70 years of age and less reliable hazard ratio calculations for age, ulceration and tumour thickness. The LifeMath.net tool was found to appropriately consider tumour thickness, ulceration, age, sex, site and tumour subtype in predicting survival. LIMITATIONS: The authors did not have access to the base data used to compile various prediction tools. CONCLUSION: The LifeMath.net prediction tool is the most reliable for clinicians in counselling patients with newly diagnosed primary cutaneous melanoma regarding their survival prospects.

Mohs' micrographic surgery of the head and neck.

Mohs' micrographic surgery, a method originally developed in the 1930s to remove contiguously spreading cutaneous cancers under precise microscopic control, has emerged as the most reliable method for removing certain primary, incompletely excised, and recurrent basal cell and squamous cell carcinomas. Indications for its use have expanded to include many other cutaneous and noncutaneous neoplasms. Usually done as an outpatient procedure and using local anesthesia, a layer of tissue is excised, mapped in relation to the site of removal, sectioned horizontally, and examined for the presence of residual tumor. This sequence is repeated, removing only tissue that contains residual tumor, until a margin completely free of cancer is reached. Extremely high cure rates are achieved, and surrounding tissue is maximally conserved for wound repair.

Hemidesmosomes, collagen VII, and intermediate filaments in basal cell carcinoma.

We have undertaken an analysis of hemidesmosomes (HD) and their associated structures, intermediate filaments (IF) and anchoring fibrils (AF), in various types of basal cell carcinoma (BCC). Using a combination of electron microscopy and immunofluorescence microscopy we show that there is a correlation between the loss of HD and tumor type (i.e., in solid and infiltrative BCC hemidesmosomes are present, sometimes in reduced numbers), while there appears to be a lack of hemidesmosomes in cells of sclerosing specimens. Moreover, even though there is a loss of cytoplasmic constituents of the HD in sclerosing forms of BCC, this is not the case with regard to collagen VII, a component of AF, which are normally associated with the extracellular side of the HD. Collagen VII is localized to the basement membrane zone of tumor cells in the absence of the cytoplasmic constituents of HD. Furthermore, deposits of collagen VII occur in the connective tissue close to tumor cell populations in all but one of the BCC specimens we analyzed. In addition to modifications in HD and AF in BCC tissue, there are changes in the cytoskeletal elements of both tumor cells and the normal appearing epidermis that overlies tumor areas. In sclerosing BCC microfilaments are commonly observed along the basal portions of tumor cells where they abut the connective tissue. IF are often found interacting with these microfilaments. Indirect immunofluorescence analysis of tumor tissue using a monoclonal keratin antibody preparation, AE1, which in normal epidermis stains basal cells, reveals that AE1 antibodies only weakly stain tumor cells. Moreover, in the epidermis that overlies tumor cell regions AE1 antibodies stain suprabasal cells and not basal cells. This change in staining pattern generated by AE1 antibodies appears to depend upon the proximity of tumor cells. These results are discussed in relation to the organization of the HD and its associated AF and IF. The possibility that HD, IF, and AF antibody preparations may be of diagnostic use is raised.

AIDS-related Kaposi's sarcoma displays differential expression of endothelial surface antigens.

The authors studied 11 cases of Kaposi's sarcoma (KS) in patients with the acquired immunodeficiency syndrome (AIDS) for their reactivity with two monoclonal antibodies (B721 and E431) that recognize endothelial cell surface antigens. Reactivity of these antibodies with KS was compared with the reactivity of other known endothelial markers (F8rAg, Ia, HCL-1). Staining was done with avidin-biotin-alkaline phosphatase immunohistochemistry on acetone-fixed frozen sections. In all samples of tumor both the spindle cell component and the vascular lining cells stained with both B721 and E431. In general, the spindle cells stained less intensely than did the vascular lining cells. There was both intratumor and intertumor variability. B721 and E431 are proposed as two additional markers for KS, and it is suggested that their reactivity with the tumor supports the hypothesis that KS is derived from vascular endothelium. The possibility is also raised that the variability of staining for vascular markers could have diagnostic possibilities, and further studies for investigation of this hypothesis are suggested.

Malignant papillary mesothelioma of the tunica vaginalis testes: cutaneous metastases showing pagetoid epidermal invasion.

Malignant papillary mesothelioma of the tunica vaginalis testis is an extremely rare tumor arising from the mesothelium of the tunica vaginalis. A total of 14 cases have been reported, with only two exhibiting cutaneous metastases. We present a third case of cutaneous metastases arising from this unusual tumor. In addition, this is the first reported case of the occurrence of pagetoid epidermal invasion in this condition.

Polycythaemia rubra vera and water-induced pruritus: blood histamine levels and cutaneous fibrinolytic activity before and after water challenge.

We studied blood histamine activity (HA) and cutaneous fibrinolytic activity (CFA) in a patient with polycythaemia rubra vera (PRV) and water-induced pruritus, before and after water exposure. The results suggest that the water-induced itching in PRV is associated with an increase in HA. In addition, markedly increased levels of CFA were found both before and after water exposure. These findings have been previously reported in patients with aquagenic pruritus (AP) but not in patients with PRV. As the water-induced itching in PRV and AP share many common features, these findings suggest that the pathophysiology of the water-induced pruritus in these two conditions may be similar.

Increased cutaneous fibrinolytic activity in aquagenic pruritus.

Aquagenic pruritus is a disease in which itchy prickling skin discomfort is evoked by contact with water at any temperature without observable cutaneous lesions. Little is known about its etiology and pathogenesis. Previous reports show that increased levels of blood histamine and cutaneous mast cell degranulation are present before water exposure and that they increase still further with water challenge. This paper shows that fibrinolytic activity is markedly increased both before and after water exposure, while circulating fibrinolytic activity is normal before water exposure in three cases of aquagenic pruritus. A patient who was asymptomatic at the time of the study had no observed increase in fibrinolytic activity either before or after water challenge, suggesting that the remission of symptoms of aquagenic pruritus and normalization of cutaneous fibrinolytic activity are interdependent factors.

Aquagenic pruritus.

The clinical characteristics of aquagenic pruritus (AP) based on a series of thirty-six patients are presented. AP is characterized by the development of severe, prickling-like skin discomfort that is without observable skin lesions and that is evoked by contact with water at any temperature. Other causes of pruritus associated with water contact must be excluded. In the thirty-six patients, skin discomfort developed within minutes of water contact in approximately half. In others, discomfort began 2 to 15 minutes after water exposure had ceased. The pruritus was usually generalized, lasting from 10 to 120 minutes (average, 40.6 minutes), and in 55% was associated with symptoms of acute emotional liability. There was no increased prevalence of atopy. Thirty-three percent reported a family history of water-related itching. Of fourteen patients treated with ultraviolet B phototherapy, eight (57%) noted significant relief. Of thirty-four patients, sixteen (47%) noted partial relief with oral antihistamine therapy. Patients with polycythemia rubra vera (PRV) may present with symptoms similar to those of AP, and all patients with symptoms consistent with AP should be investigated for the presence of PRV.