Profile of the malignant melanoma excised in general practice

Abstract

An analysis of 27 malignant melanomas diagnosed in a Dutch laboratory specializing in the provision of a cytology and pathology service to general practitioners is reported. The median age of the patients was 39 years, and was lower in women (30 years) than in men (54 years). In the national data the mean age was 52 years for both sexes. There were twice as many women as men. There were no tumours from the head and neck region. The ratio of tumours on the limbs to those on the trunk was 3:2. The melanomas were very small (74% with a diameter of < or = 6.0 mm), and they were also very thin (74% with a Breslow thickness < or = 1.0 mm), compared with the national data in which 62% were < or = 1.0 mm. Not surprisingly, the estimated mean 5-year survival was favourable (95% for women and 76% for men). After a period of follow-up ranging from 2 to 32 months, none of the patients had any evidence of residual disease. This study demonstrates that in skin biopsies performed by general practitioners melanomas are mainly detected by chance, and have a very good prognosis.

Cutaneous Melanoma: Preoperative Tumor Diameter in a General Dermatology Outpatient Setting

“…In five of the available published reports on tumor diameter (Table 5), measures were obtained after tumor excision and tissue processing (ex vivo). 3,[6][7][8][9] Ex vivo measures do not account for postoperative tissue shrinkage related to skin elasticity and additional shrinkage related to formalin fixation. Total amounts of tissue shrinkage immediately after excision and after formalin fixation has been reported to range from 20% to 31% and is highly dependent on patient age, obfuscating reliable prediction of preoperative tumor diameter from postoperative specimens.…”

“…Our study included tumor diameter only if recorded measures were available preoperatively (in vivo). In five of the available published reports on tumor diameter (Table ), measures were obtained after tumor excision and tissue processing (ex vivo) . Ex vivo measures do not account for postoperative tissue shrinkage related to skin elasticity and additional shrinkage related to formalin fixation.…”

Cutaneous melanoma and intervention strategies to reduce tumor-related mortality: what we know, what we don't know, and what we think we know that isn't so

“…These findings are not surprising if CM enlarges and thickens over time, accounting for thicker and larger lesions in older patients, compared to younger patients. In a general practice case series of 27 CMs (in situ or invasive) diagnosed from 1988 to 1990 in the Netherlands, 20 cases (74.1%) had a diameter of 6 mm or less (17). Among 121 cases of primary CM in situ in 113 patients diagnosed in Milan, Italy between 1975 and 1993, 27 cases (22.3%) had a diameter of 6 mm or less (18).…”