Faculty Bibliography

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

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

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

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

A total of 357 white patients who had melanocytic nevi that fulfilled the clinical criteria for the 'classic' atypical-mole (dysplastic-nevus) syndrome (100 or more melanocytic nevi; one or more melanocytic nevi 8 mm or larger in diameter; and, one or more melanocytic nevi with atypical features) were followed for the development of cutaneous malignant melanomas. Seventeen patients (4.8%) developed malignant melanomas during an average follow-up period of 49 months. One patient developed two malignant melanomas. Eight of the malignant melanomas detected were in situ and ten were invasive melanomas (less than 0.86 mm in Breslow thickness), implying an excellent prognosis. The number of malignant melanomas detected in these patients exceeded significantly the number expected to occur in age- and sex-matched white controls. All groups were shown to have an increased risk for the development of malignant melanomas. Total-body photographs were helpful in detecting changes in size, shape, and color that led to the diagnosis of malignant melanoma. These data support the concept that patients with this readily regionalized clinical presentation of classic atypical-mole syndrome are at an increased risk for malignant melanomas and, therefore, should be examined regularly

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