Correct staging is crucial for the management and prognosis of patients with malignant melanoma. The aim of this prospective study was to compare staging by whole-body positron emission tomography using fluorine-18 fluorodeoxyglucose (18F-FDG) with staging by conventional methods. Thirty-eight patients with malignant melanoma of clinical stage II (local recurrence, in-transit and regional lymph node metastases) or III (metastases to other sites than in stage II) were included in the study. The results of the PET scans were compared with those obtained by clinical examination, computed tomography, ultrasound, radiography, and liver function tests and histology or clinical follow-up. With 18F-FDG PET we found for all foci a sensitivity of 97% and a specificity of 56%, compared with 62% and 22%, respectively, when using routine methods. For intra-abdominal foci, the sensitivity and specificity were 100% for both 18F-FDG PET and routine methods. Corresponding figures for pulmonary/intrathoracic foci were 100% and 33%, respectively. Of the patients included in this study, 34% would not have been staged correctly by conventional methods alone. We conclude from this study that 18F-FDG PET is a sensitive method superior to conventional methods for detecting widespread metastases from malignant melanoma. Mutilating surgery of no benefit can thereby be avoided. 18F-FDG PET is useful as a supplement to clinical examination in melanoma staging.

Background. Local recurrence is one of the major problems in treatment of breast cancer. Approximately 20% of patients who have radical or modified radical mastectomy have a local recurrence. Methods. The records of 98 women with locally recurrent breast cancer treated with wide local excision, in the years 1983–1987, were reviewed. The median age at excision was 62 years (range, 32–84 years). All patients were observed until death or December 31, 1989. The median follow‐up period was 36 months (range, 2–79 months). Results. At follow‐up, 44 of 98 patients (45%) had had a new local relapse and 47 of 98 (48%) were dead. The median duration of local control for all patients was 21 months (range, 1–79 months). The diameter of the local recurrence seemed to influence the duration of local disease control but not total survival. Patients admitted directly for surgery had a longer period of local control compared with patients admitted after unsuccessful oncologic treatment of the local recurrence. The 5‐year local control rates were 50% and 24%, respectively (P > 0.92). No statistically significant difference in local control could be shown whether or not the patient received additional oncologic therapy in continuity with the wide local excision. The 5‐year local control rate in patients treated only by surgery was 33% compared with 42% in patients also receiving additional oncologic treatment (P > 0.63). Conclusions. Wide local excision of recurrent breast cancer seems to provide as good or even better local control than other treatment modalities. Surgery should not be postponed in cases of ineffective medical treatment or radiation therapy.

Serial measurements of C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were performed during the week after operation in 140 patients with hip fractures. There was no selection, and patients with minor or major complications before or after operation were included. In uncomplicated cases, the ESR was variably raised during the first week, whereas the CRP showed a distinct pattern with a rapid increase on the second day; it then decreased by the 7th day. In cases with early postoperative bronchopneumonia and deep wound infection, the CRP was high, but minor infections did not influence the usual levels. Complications had no effect on the ESR during the 1st week.

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The clinicopathologic and therapeutic data of 512 patients, with clinical Stage I invasive head and neck melanoma of the skin were retrospectively evaluated. There were 287 females and 225 males. Median age at primary surgery was 65 years (range, 18 to 96 years). Median observation period was 5 years (range, 1 month to 25 years). Site of first recurrence was local in 7% (38 of 512), regional in 13% (67 of 512) and distant in 6% (31 of 512). Sex, age, ulcerated tumor, and tumor thickness were found to act as independent risk factors to recurrencefree survival by Cox multivariate regression dnalysis. In addition, size of excision margin was found to be of no significance to survival without relapse when adjusting for the independent risk factors. Cancer 1992; 69:1153-1156.There is a trend of reducing excision margins in the treatment of cutaneous malignant melanoma.' It remains unknown how extensive primary surgery ought to be in the head and neck region to minimize the risk of recurrence or death caused by this disease.* Excision margins in this particular region often are reduced either in an attempt to preserve important anatomic structures or because of advanced age of the patient.The aims of this retrospective study were to identify prognostic variables of importance to recurrence-free survival with special attention paid to size of excision margin. Patients and MethodsSix hundred twenty patients had surgery for head and neck melanoma (HNM) during the period from 1949 to 1986 at the Department of Plastic Surgery, of the Finsen Institute and later the Rigshospital, Copenhagen. Eighteen patients with noninvasive melanoma (Clark's Level I), 1 patient with melanoma of the conjunctiva, 36 patients with demonstrable signs of metastases at primary surgery, and 53 patients without histologic material suitable for re-examination were excluded from this study. The records of 512 patients (287 females and 225 males) were reviewed. The median age of the patients was 65 years (range, 18 to 96 years).Clinical data of interest were sex, age at primary surgery, subsite of tumor, excision margin (i.e., minimum distance from the edge of tumor to the margin of the final excision given by the surgeon in the operative notes), recurrence-free survival, and site of relapse, which was classified as "local" when in or near the scar but in the same subsite as the primary tumor, as "regional" when in the regional lymph nodes, and "distant" when metastases were found elsewhere. If there were simultaneous metastases to more than one subsite, the subsite associated with the worst prognosis was noted.The histologic material was re-evaluated and classified by the same two pathologists (K. H.-J. and K. s.).The classification included histologic type and level of invasion according to Clark,3 thickness according to Bre~low,~ and ulceration. All patients were followed up clinically at regular intervals from the primary operation to the first recurrence, to death, or to the closing date of this study (December 31,1989). The median time of obse...

The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980-1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period. At reexamination of the primary tumors, 16 were found to be malignant melanomas and 9 were nevi (four atypical and five benign). Twenty-one were missing, 11 of which had never been set for histologic examination. The median thickness of nine measurable melanomas was 0.66 mm. The recurrences in scar consisted of 34 primary melanomas: 18 superficial spreading, 4 nodular, 3 lentigo malignant, and 9 unclassified. Twelve tumors were dermal melanoma metastases. The median thickness of the 25 measurable melanomas was 0.78 mm. The 5-year overall survival was 69%. At the closing date of the study 15 patients had died, 13 of them because of disseminated melanoma. A comparison of the survival curves from this study with those from other series of melanomas with comparable tumor thickness indicates a considerably worse prognosis than is expected with such thin tumors. We believe that the considerable number of local recurrences in the form of a new primary in a scar following limited surgery supports the theory of limited field change around a primary melanoma. Furthermore, limited procedures for primary melanoma, if followed by a recurrence in the scar, worsen the prognosis.

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