Effect of BANS location on the prognosis of clinical stage I melanoma: new data and meta-analysis.

Intermediate thickness (0.76-1.69 mm) clinical stage I melanomas at BANS locations (upper Back, posterior Arm, posterior Neck, posterior Scalp) were initially reported to have worse prognosis than similar thickness lesions at other subsites. Subsequent investigation did not support this observation. We re-examined the hypothesis in 156 consecutive patients with clinical stage I melanomas in this thickness range, who were seen at the Massachusetts General Hospital from 1977 to 1985. Patients with BANS lesions suffered recurrences at twice the rate of those with non-BANS lesions (28% compared with 13% at 5 years after excision of the primary melanoma), but this difference was not statistically significant. A meta-analysis of the effect of BANS subsite on death risk was performed using data from our investigation and five comparable published studies. The original data set which led to the BANS hypothesis was excluded from the meta-analysis in order to avoid bias. BANS location was associated with a 60% increased risk of death (P = 0.002). The difference remained statistically significant after elimination of any two of the six studies from the analysis. This confirms the influence of anatomical subsite on the prognosis of intermediate thickness melanoma.

Lymphomatoid papulosis following Hodgkin's disease.

Lymphomatoid papulosis has occurred in association with Hodgkin's disease. In all cases previously described, Hodgkin's disease has developed after, or concurrently with, the onset of lymphomatoid papulosis. Two patients who developed lymphomatoid papulosis 1 and 10 years after the diagnosis and therapy for advanced Hodgkin's disease are reported. The purpose of this report is to document this unusual sequence.

Does wide excision as the initial diagnostic procedure improve prognosis in patients with cutaneous melanoma?

502 patients with clinical stage I cutaneous melanoma were reviewed to determine if performing a wide excision (4-5 cm) at the time when the diagnosis of melanoma is suspected, improves the survival. Patients were divided into two groups based on initial biopsy type and thickness category. Group 1, wide excision; group 2, total excision with narrow margins, incisional, or punch biopsies. There was no evidence that patients who had had a diagnostic and therapeutic procedure (wide excision) as the initial approach had a better survival than those who had had another form of biopsy before definitive surgery. We cannot recommend excision with wide margins as the initial biopsy procedure for a lesion suspected to be melanoma before histologic verification, since it does not increase survival for melanoma and may result in unnecessary aggressive surgery in the case of a misdiagnosed benign lesion.

Does biopsy type influence survival in clinical stage I cutaneous melanoma?

A total of 472 patients with clinical Stage I cutaneous melanoma were analyzed to determine influence of type of diagnostic biopsy on survival. Of these patients, 119 had had an incisional biopsy (either punch or incision) and 353 had an excisional biopsy. Patients were grouped by thickness category and outcome compared between the biopsy types. Within each thickness category, there is no statistically significant difference in survival between the two groups. The observation that none of the seventy-six patients with primary tumors less than 1.70 mm have died following incisional biopsy strongly argues against any deleterious effect of incisional biopsy in this group. Alternatively, if the two highest-risk groups (greater than or equal to 1.70 mm) are analyzed as a single group, an adverse effect is seen in the incisional biopsy group (p less than 0.05). However, when the data from these groups are subjected to multivariate analysis, biopsy type is not a significant factor in the model. This study shows that either biopsy method may be used in first evaluating patients with suspected melanoma.

Immunosuppression: a cause of porokeratosis?

Two patients are reported in which the development of porokeratosis occurred following chemotherapy for systemic malignancy. Immunosuppression associated with malignancy and chemotherapy may exacerbate or initiate the development of porokeratosis in patients predisposed to alterations of cutaneous growth dynamics.

Influence of estrogen administration on tumor characteristics and survival in women with cutaneous melanoma.

A prospective study on 289 women with clinical stage I cutaneous melanoma was done to determine the relationship between estrogen administration, tumor characteristics, and survival. Eighty-two women took oral contraceptives (OC) and 44 took menopausal estrogens (MPE) prior to the diagnosis of melanoma. Users of OC presented with thinner primary tumors than nonusers of OC (P less than .01). A similar trend was observed in users of MPE. Women who used OC in the year prior to the diagnosis of melanoma had statistically thinner tumors than those who had discontinued use of OC more than 1 year prior to diagnosis (P less than .025). A statistically significant preponderance of truncal lesions was observed among users of OC (P less than .01). Other tumor characteristics were unaltered by estrogen administration. Duration of use and time in relation to diagnosis of melanoma did not affect survival. Women who took hormones had slightly better 5- and 9-year survival rates than nonusers. These results suggest that prior estrogen use and, particularly, use of OC in women developing melanoma have no deleterious effect.

Skin markings in the diagnosis and prognosis of cutaneous melanoma.

Skin markings and pathologic findings in 105 patients with cutaneous melanoma were reviewed to determine relationship between clinical findings, pathologic findings, and prognosis. Lesions with decreased or absent markings are significantly thicker than those with increased or normal markings and therefore carry a worse prognosis. Loss of skin markings is a late sign of melanoma and should not be relied on as an aid in early diagnosis.