Of 980 patients with malignant melanoma treated during the past seven years, 55 (5.6%) were found to have metastatic disease and no detectable primary tumor. Thirty-six of these patients with "unknown primary melanoma" had disease limited to lymph nodes (Stage II), whereas 19 had disseminated melanoma (Stage III). The sex and age distribution of these 55 patients were similar to those of a control group of 86 patients with palpable lymph node metastases from a known primary. The site of lymph node metastases for Stage II patients in each group was similar although unknown primary patients seemed to have slightly more involved lymph nodes. By studying patients with the same stage and similar extent of disease, the prognosis of unknown primary melanoma could be determined and compared to known primary melanoma. The overall recurrence rate of patients with unknown primary was no higher than that of patients with known primary. This observation appeared to be true even when patients were compared with respect to adjuvant immunotherapy. The use of adjuvant immunotherapy appeared to favorably affect recurrence rates among the unknown primary patients. Since the recurrence rate for patients with unknown primary melanoma was no higher than that of patients with known primary melanoma, we advocate aggressive surgical management. The occasional long-term survivor with Stage III unknown primary suggests that judicious surgical intervention may benefit these patients as well.
From a series of 712 patients with melanoma, 38 patients (5.3%) had more than one primary melanoma. Twenty-four patients had two primaries, 11 patients had three, 2 patients had four, and l patient had eight. Twelve patients (32%) had one or more synchronous primaries. Forty-five percent of all multiple primaries were diagnosed within the first year. Microstaging by level and depth was determined prior to treatment and in patients with nonsynchronous primaries, 83% had a subsequent melanoma equal or less advanced than the original. Twenty-six patients with Stage I primaries were skin-tested with DNCB prior to therapy. No significant differences in delayed cutaneous hypersensitivity reactions were found between multiple primary and matched controls with only a single melanoma. Four of 10 patients with multiple primaries treated with adjuvant BCG or BCG-tumor cell vaccine developed subsequent melanomas suggesting that immunotherapy with BCG will not prevent the development of a new primary melanoma. Survival in patients with Stage I and I1 multiple primary melanomas was improved compared to Stage I and I1 patients with a single primary. This study suggests that prognosis in multiple primary melanomas is better reflected by the most advanced primary based on microstaging and the presence or absence of regional lymph node metastases than by multiplicity.Cancer 43:939-944, 1979.
Endarterectomy sections of canine aorta were examined in various stages of healing by scanning electron microscopy. In all specimens the endarterectomy site was quickly covered by a thin fibrin-platelet coagulum with varying amounts of thrombus. Neoendothelization began before one week and was virtually completed by one month except on areas of heavy thrombus deposition. While this study does not prove the origin of the neoendothelial cell, it suggests that neoendothelial cells are derived from pre-existing endothelium and advance over the endarterectomy site from the junction zone of the normal aorta and to a lesser extent from the orifices of brancing vessels.
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