One hundred patients with a diagnosis of head and neck cancer were investigated carefully for a history of alcoholism. A majority of cases had a severe drinking problem; in fact, alcoholism was twice as common as initially anticipated. Patients were frequently able to hide the problem from their physician. Often the true diagnosis was obtained only by closely questioning relatives and friends. Most patients with cancer of the tongue, tonsil and oro-pharynx were alcoholic. About one-half of the patients with supraglottic carcinoma were alcoholic. In the nasopharnx and true vocal cords, there was no association with heavy drinking. The study is of epidemiological interest but also has implications in the management of the malignancy, depending upon the anatomic site involved.

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All cases of cutaneous malignant melanoma, CMM, diagnosed in Northern Ireland between 1974-1978 were reviewed, classified and followed up until the end of 1984. The overall 5 year survival is 54%, among the worst reported in recent literature. Multivariate analysis of these cases confirms some previous findings from other studies, but also reveals features not apparent in univariate analysis. Prognosis worsens with increasing thickness and the presence of ulceration. Likewise histopathological type has an independent effect on survival, ALM having the worst prognosis. Tumour profile emerges as a significant feature affecting prognosis, flat lesions having the poorest outlook, given their thickness. Survival is worse with increasing age. Anatomical site is less important than suggested by previous univariate analysis. Sex has little influence on prognosis when adjusted for the other variables. Cell type and pigmentation are of no prognostic value. Several features including diagnostic delay contribute to the poor overall survival for CMM in Northern Ireland. Educational intervention is essential if this trend is to be reversed.

Summary Three hundred and four suspected cases of malignant melanoma diagnosed in Northern Ireland over a 5 year period have been reviewed. Two hundred and forty fulfilled the diagnostic criteria of invasive cutaneous malignant melanoma (CMM) and were accepted as suitable for analysis an incidence of 3.12. The female to male ratio for CMM in this study is 3:1. This excess of female lesions occurs at all major anatomical sites and for all tumour types. There are many thick melanomas in the province, and 67% of cases were greater than 1.7mm thick. Each tumour type has a distinctive age curve. The implications of these findings are discussed. The evidence suggests that intrinsic factors are as important as extrinsic factors.Malignant melanoma is a potentially lethal form of skin cancer. Its incidence and mortality is increasing in most countries studied. The disease is found in a younger age group than most other forms of cancer. Different forms of melanoma may have different patterns of incidence, growth and prognosis.Apart from Scotland (MacKie & Hunter, 1982) it has been unusual to use the population of an entire country as the basis for a study of melanoma and correlate histopathological parameters with age, sex and site. Northern Ireland is a relatively closed geographical entity with sufficient numbers of cases for analysis. Moreover its limited size allows accessibility to virtually all patients. A detailed' histopathological examination of all cases of melanoma referred to the three pathology centres over a 5-year period was therefore undertaken.The population of Northern Ireland was 1,538,800 at the time of this study. It is situated between 54°N and 56°N latitude. There is a maritime climate and the annual solar radiation incident on a horizontal surface is 1,000kWh per square meter (Cruikshank & Wilcock, 1982 cases were accepted for the study. There are only three pathology centres in Northern Ireland and all biopsy specimens are submitted to these centres. Through the kind co-operation of the consultant pathologists, the histopathological records of the three centres were completely reviewed for the 5-year period between 1974-1978. The only possible cases of melanoma that might not be included in this survey would presumably be those cases not submitted for biopsy. At a joint melanoma group meeting with general surgeons, plastic surgeons, pathologists, dermatologists and other clinicians in the province, it was considered that very few cases of melanoma would escape histopathological confirmation in Northern Ireland.Eye lesions, metastases from primaries diagnosed previously, and second excisions were all excluded. Cases of multiple primary melanoma were only considered if the first primary occurred during the period of study.Three hundred and four cases were thus available for study. Of these, 15 cases of lymph node melanoma had no identifiable primary site and were excluded because no cutaneous melanoma has been found. The remaining 289 cases were histopathologically examined. Eight cases of anal, vag...

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