Treatment of Melanoma

141

Two biologically and clinically different malignant melanomas are found in man. As compared to the malignant melanoma developed from junction nevus, the melanoma developed from Dubreuilh's precancerous melanosis has a slower rate of growth, metastasis and invasiveness. Furthermore, in contrast to melanoma of junction nevus origin, melanoma from Dubreuilh's melanosis is radiosensitive and does not assume the amelanotic form. Not only the malignant melanomas but also the premalignant stages exhibit differences. Dubreuilh's precancerous melanosis, in contrast to junction nevus, is a condition which occurs during later life in exposed areas, is radiosensitive and has a high incidence of malignant transformation. Cellular and subcellular differential characteristics expressing enzymic and ontogenic differences of these two melanomas are described. The author proposes that in the future we consider human malignant melanoma to be not one but two diseases—melanocytic malignant melanoma and nevocytic malignant melanoma. These may be called malignant melanocytoma and malignant nevocytoma, respectively.

Melanocytic and nevocytic malignant melanomas.Cellular and subcellular differentiation

Mishima

1967

141

Malignant melanoma of the external ear

Ward

Acquarelli

1968

Little information has been published on experience with surgical treatment of malignant melanoma of the external ear. Review of the literature and four representative cases admitted to the Wadsworth VA Hospital between 1947 and 1967 provides a basis for therapeutic recommendations. Elective neck dissections are advocated because approximately 40% of melanoma patients treated by local excision alone eventually will develop regional node metastases and because of the high incidence of microscopic malignancy in clinically negative neck dissection specimens. Earlier diagnosis and treatment by surgeons who apply the established principles of radical surgery for cancer can result in improved surviyal rates as demonstrated by our 19‐year survival of stage II melanoma treated by amputation of the affected auricle in continuity with a radical neck dissection.

Clinical trials of combination chemotherapy with BCNU and vincristine in the treatment of malignant melanoma in Uganda

Primack

Dhru

Kiryabwire

et al. 1973

Sixteen Ugandan patients who had advanced malignant melanoma were treated with a combination of BCNU and vincristine, but only two transient objective tumor responses (13%) were observed. Drug toxicity at the doses used in the present study did not result in clinical complications, and no drug‐related deaths were seen. Leukopenia was observed in all patients but the WBC never fell to less than 1500/mm3. Platelet counts were consistently above 100,000/mm3. The results of therapy with the BCNU‐vincristine combination for advanced malignant melanoma, which have been promising in the United States, have been disappointing in Ugandan patients.