The aim of this study was to examine the interest which patients with malignant melanoma may have in a six week psycho-educational group intervention and determine factors that are associated with their degree of interest. Of 144 outpatients, 121 (84%) agreed to participate in the interview (78 women, 66 men, mean age 59, SD=15; mean time since surgery=57 months, SD=55). About one-third (29%) of the sample had either nodal or in-transit metastases. A semi-structured interview was conducted to assess patients' interest (perceived need) in the intervention. We administered the Hornheide questionnaire and other psychosocial measures to identify highly distressed patients (expert-defined need). Lower age, being male, having no partner and lower cognitive avoidance emerged as significant predictors for a general interest in the intervention (n=92). A substantial number of patients (42.5%) stated a willingness to participate in the intervention at that time. Two problematic subgroups could be identified in the sample: patients in an expert-defined need of support who lacked any interest ('avoiders') and interested patients without an expert-defined need ('skilled help-seekers'). In order to achieve consistent results when conducting future interventions, the interventions should either be limited to patients with expert-defined need or patients should be carefully controlled for this variable.
Ultraviolet (UV) radiation causes significant impairment of immunological function in human skin. The immunosuppressive effects of UV radiation are thought to be due to local release of cytokines by human keratinocytes, leading to impaired function of epidermal antigen-presenting cells (APC) and failure to induce cutaneous delayed-type hypersensitivity (DTH) reactions. Recent studies have shown that individuals susceptible to UV-induced suppression of DTH may be more prone to develop skin cancer including malignant melanoma (MM). Since the causal relationship between UV radiation and the induction of MM still seems obscure, we investigated the immunological reactions of peripheral blood mononuclear cells (PBMC) to whole-body irradiation with UVB in 15 stage I melanoma patients as compared to PBMC from normal volunteers matched for age, gender and skin type. Whole-body irradiation was performed with 0.8 minimal erythema dosages on five consecutive days. Peripheral blood was obtained before and after the procedure. Overall, there were no major effects of UVB irradiation on peripheral lymphocyte subsets and proliferation of PBMC from patients or normal controls, but UVB irradiation led to a significant increase in PWM-stimulated production of IL-6, IL-2R and TNF by PBMC. These changes were independent of the individual UVB dosages administered and appeared in both groups similarly. UVB irradiation did not lead to significant changes on IL-1 and IL-2 expression by PBMC. Our results suggest that PBMC participate in the cytokine response to UV, even in the absence of inflammatory reactions, but that this participation is not specific to MM patients.
The efficacy of treatment with fotemustine and interferon (IFN) alpha was evaluated in metastatic melanoma. A group of 50 patients with metastatic malignant melanoma were treated with a combination of IFNalpha2b and the nitrosourea fotemustine. The patients received 10 MU IFN three times weekly for 3 weeks and fotemustine at a dose of 100 mg/m2 on days 8, 15 and 22. After a 5-week rest period, patients with stabilized or responding disease received a maintenance therapy consisting of 10 MU IFN three times a week for 1 week followed by administration of fotemustine (100 mg/m2) on day 8. This cycle was repeated every 4 weeks until progression occurred. If there was complete remission (CR), treatment was stopped after an additional three cycles. Toxicity and clinical response were scored according to WHO criteria. Objective response was seen in 14 patients (28%; 95% confidence interval 15.6%-40.4%) with four CR and ten partial responses (PR). The median duration of CR was 73 weeks, that of PR 26 weeks. Toxicity was acceptable, enabling treatment on an outpatient basis. The combination of fotemustine with IFNalpha is effective and well tolerated, but there is no evident advantage over fotemustine monotherapy in the treatment of metastatic melanoma.
Flow cytometric analysis of T-cell surface markers in peripheral blood has revealed abnormal patterns in patients with cutaneous T-cell lymphomas (CTCL). Here we investigated CD7, CD25, CD45RO and CD45RA expression on CD4+ T-lymphocytes in patients with CTCL stage I/II and III/IV and in patients with severe inflammatory skin diseases (ISD), as well as in healthy controls. Only late stage CTCL (III/IV) showed a lymphocytosis with a distinct surface marker pattern: CD3+, CD4+, CD8-, CD7-, CD45RO+, CD45RA-. Early stage CTCL (I/II) showed normal lymphocyte counts, a normal T-helper cell expression of CD7, CD45RO and CD45RA, and a slightly increased percentage of CD4+ CD25+ lymphocytes, which was also found in ISD. It is concluded that flow cytometric analysis of the above T-cell surface markers may be useful in the diagnosis of patients with late stage CTCL. However it does not allow us to distinguish patients with early stage CTCL from patients with ISD or controls.
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