Aetiological factors in cutaneous malignant melanomas seen at a UK skin clinic.

A clinic-based case-control study was set up in 1961 to examine a variety of aetiological factors in malignant melanoma cases compared with controls with other non-malignant skin conditions. The 268 cases and 1577 controls showed odds ratios of 1.9 for red hair, 2.0 for skin that burns in the sun, and no difference between indoor and outdoor workers or between Celts and other Europeans, consistent with the results of more recent studies. Exposure to 16 specific chemicals was recorded in the study and, among these, men exposed to cutting oils were found to have a significantly raised odds ratio of 1.91. Other statistically significant findings were an elevated risk among women diabetics, particularly in the postmenopausal age group, and a reduced risk of 0.7 among cigarette smokers.

Influence of environmental factors excluding ultra violet radiation on the incidence of skin cancer.

Cancers of the skin are not properly registered and our lack of precise knowledge of the influence of environmental factors is due both to a failure to report and a failure to attribute because many tumours are not recognised as due to environmental factors and escape notification due to lack of knowledge and teaching. The long latent period also interferes. The commonest cancer is squamous cell carcinoma followed by basal cell carcinoma. Melanoma is exceedingly rarely environmental. The main causative agents are: Polycyclic aromatic hydrocarbons (PAH), inorganic arsenic and ionising radiation. PAH induce 4 times more cancer of the scrotum in workers using cutting oils or pitch than expected. These subjects have also increased incidence of second primaries of both the skin and internal organs. The latent period varies from 20 years (exposure to coal tar) to 50 years or more (exposure to mineral oils). Exposure to pitch may result in 11 fold increase incidence of squamous cell carcinoma. Skin cancer due to arsenic is rare. It has been seen in sheep dip workers, in patients treated with Fowler's solution and in vineyard workers using arsenical pesticides and drinking contaminated wine. The latent period may go up to 60 years. Ionising radiation over 1,000 rems may cause basal and squamous cell carcinoma. The latent period varies from 7 weeks to 56 years (average 25--30 yrs).

Unusual cutaneous associations of a malignant carcinoid tumour of the bronchus--erythema annulare centrifugum and white banding of the toe nails.

The case history of a patient who presented with erythema annulare centrifugum and white banding of the toe nails is recorded. On investigation for an underlying malignancy the patient was found to have an opacity in the lower lobe of the right lung. Subsequently lobectomy was performed and histology of the operative specimen revealed a malignant carcinoid tumour of the bronchus.

Immunofluorescent patterns in the skin in Besnier's prurigo. The eczema asthma syndrome.

The immunofluorescent patterns in the skin of eighteen patients with Besnier's prurigo were studied at different stages of eczematous lesions. The presence, distribution pattern, and numbers of immunoglobulin and complement-positive lymphocytes in twenty-nine biopsies are reported. In all cases IgE-positive lymphocytes were present in both clinically uninvolved and involved skin. IgG, IgM and IgE-positive lymphocytes showed a characteristic distribution pattern in the dermis. In the acute stages IgM deposition was prominent in the basement membrane zone and it is suggested that damage to the basement membrane results in diffusion of immunoglobulin and complement into the epidermis. These features were not present in a control group of normal skin and of other dermatoses.

Treatment of primary melanoma by intralesional vaccinia before excision.

The results of treatment of two groups of patients with primary melanoma are compared. 25 patients in group 1 were treated by wide local excision of the primary melanoma, and 23 in group 2 were treated by vaccination with live vaccinia virus 14 days before wide local excision. Vaccination exerts a favourable effect on the course of melanoma both in terms of survival and prolongation of the interval between treatment of the primary lesion and subsequent development of metastases.