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Lesion thickness and prognosis in melanoma: horses are not zebras. A response to Green and Ackerman
Rigel DS; Kopf AW; Friedman RJ
PMID: 8238784
ISSN: 0193-1091
CID: 6496
The gender-related issues in malignant melanoma
Rigel DS
The problem of malignant melanoma is important in the United States, in the world as a whole, and particularly in Hawaii with its high levels of ultraviolet radiation. It is estimated that 32,000 Americans will develop melanoma and 6,800 will die of this tumor in 1993. Melanoma is now the seventh most frequent cancer in the United States. It is more common than ovarian, cervical, CNS cancer and leukemia. Both incidence and mortality from melanoma are rapidly increasing. The incidence of melanoma has consistently increased 6% a year and the death rate has increased 2% a year since 1950. At current rates, one in 400 will die of this tumor. Should this rate of increase continue, by the year 2000, it is estimated that one in 75 Americans will develop melanoma during a lifetime. The highest melanoma incidence in the U.S. is found in Hawaii. Melanoma is increasing faster than any other cancer in the United States and all over the world
PMID: 8320089
ISSN: 0017-8594
CID: 13182
Influence of gender on survival in patients with stage I malignant melanoma
Vossaert KA; Silverman MK; Kopf AW; Bart RS; Rigel DS; Friedman RJ; Levenstein M
BACKGROUND: Women with stage I malignant melanoma (MM) have a survival advantage over men as judged by univariate analysis. However, on multivariate analysis, gender was found to be an independent predictor of survival in only 8 of 14 published studies. OBJECTIVE: This study attempts to explain the disparate findings for gender as a prognostic factor in different multivariate analyses. METHODS: Univariate and multivariate analyses were performed on 832 patients with stage I MM in the New York University Melanoma Cooperative Group (NYU-MCG) data base. The results were compared with those of 14 similar studies. RESULTS: In the NYU-MCG data base, gender, age of the patient, and number of mitoses per square millimeter were not independent factors on multivariate analysis, whereas thickness, anatomic site, and presence of ulceration were. The statistically significant difference in survival by gender on univariate analysis, in the NYU-MCG data base, could be explained by the differences in thickness and anatomic site of the MMs in the sexes. Comparison of these results with the reviewed reports from the literature consistently shows thickness and ulceration to be independent prognosticators of survival. Likewise, most authors agree that age is not an independent predictor. However, there is no consensus with respect to gender and site, each of which was found to be an independent predictor of survival in only about half the studies reviewed. CONCLUSION: The disparate findings for gender in different multivariate analyses are explained by a gender-related difference in anatomic distribution of MM. Gender and site appear to have a similar influence in multivariate analysis and thus either one or the other is a dominant factor in different multivariate analyses
PMID: 1564150
ISSN: 0190-9622
CID: 13671
Level of education and the risk of malignant melanoma
Lee PY; Silverman MK; Rigel DS; Vossaert KA; Kopf AW; Bart RS; Garfinkel L; Levenstein MJ
BACKGROUND: The risk for the development of malignant melanoma has been reported to be higher in persons with more formal education than in individuals with less. OBJECTIVE: To study whether those with more formal education are indeed at more risk for malignant melanoma than those with less formal education. METHODS: This case-control study explores the relation between education and melanoma risk by analyzing data collected by the American Cancer Society. A total of 1.2 million people were surveyed for a history of cancer and followed up for 6 years for the development of any cancer. In total, 2780 white persons had a history of malignant melanoma or developed malignant melanoma during the study period. The controls were age-, sex-, and geographically matched white persons selected from the remaining people enrolled. RESULTS: Both men and women were shown to have a statistically significant increase in the relative risk for malignant melanoma with increasing education level (p less than 0.001 and p = 0.001, respectively). This relation was more striking in men when the relative risk with 95% confidence interval was calculated by sex for each education level. CONCLUSION: Americans with more formal education are at greater risk for malignant melanoma than those with less education
PMID: 1732337
ISSN: 0190-9622
CID: 13721
The dilemma of the dysplastic nevus
Rigel DS
PMID: 1642417
ISSN: 0148-7043
CID: 13733
Epidemiology and prognostic factors in malignant melanoma
Rigel DS
The rising rate of MM reflects damage to the skin that has been done in the past. If a difference is to be seen prospectively, we must use protection (sunscreens) and have suspicious areas evaluated early in their course so that MM can be treated when curable. Until further research yields a cure for advanced MM, the above approach remains the first line of defense in the fight against this cancer
PMID: 1642410
ISSN: 0148-7043
CID: 13734
Computer applications in the diagnosis and prognosis of malignant melanoma
White R; Rigel DS; Friedman RJ
Recent advances in computer technology have begun to make computers a more effective tool in the diagnosis and evaluation of malignant melanoma. Preliminary computer-aided diagnosis programs have been developed. Histologic evaluation applications in both diagnosis and prognosis are also evolving. Further advances in computers may make them an integral part of the diagnosis and prognosis of melanoma in the future
PMID: 1934644
ISSN: 0733-8635
CID: 13871
Distinguishing benign and malignant melanocytic lesions with the AgNOR method
Friedman RJ; Grin CM; Heilman E; Weiser J; Gottlieb GJ; Waldo E; Rigel DS; Kopf AW
A silver staining technique has recently been devised to aid in the differentiation between benign and malignant melanocytic lesions. This study showed a statistically significant difference between the staining of silver-nucleolar organizer regions (AgNORs) in melanocytic nevi and that of AgNORs in malignant melanomas
PMID: 1934643
ISSN: 0733-8635
CID: 13872
Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation
Friedman RJ; Rigel DS; Kopf AW; Grin CM; Heilman E; Bart RS; Kamino H; Harris MN; Roses DF; Postel AH; et al
There are many clinical and histologic factors that are known to be valuable in predicting survival rates for patients with cutaneous malignant melanomas. Breslow thickness is considered to be the most reliable prognostic factor; however, thickness is a unidimensional measurement. A more accurate mensuration to predict biologic behavior might be one that takes into account the three-dimensional volume of the neoplasm. In a study of 35 primary malignant melanomas, the volumes of the dermal components of the tumors were calculated. Those patients with tumor volumes of 200 mm3 or less had a 91.4% 5-year disease-free survival rate, compared with survival rate of only 16.7% for those patients whose lesions had tumor volumes exceeding 200 mm3. On multivariate analysis, tumor volume exceeded thickness as a prognostic indicator. Thus, measurement of tumor volume proved to be of greater significance than thickness in predicting the outcome for patients with malignant melanomas
PMID: 1934639
ISSN: 0733-8635
CID: 13874
Factors influencing survival in melanoma
Rigel DS; Friedman RJ; Kopf AW; Silverman MK
Multiple factors appear to influence survival of patients with MM. As computer and mathematic analysis techniques advance, the specific effects of these variables, in terms of their impact on survival rates, will be delineated better
PMID: 1934638
ISSN: 0733-8635
CID: 13875