Faculty Bibliography

This report verifies the ability of a Prognostic Index (PI) to accurately predict 5-year survival rates for 879 Stage I cutaneous malignant melanoma (MM) patients seen at New York University Medical Center. The PI used in this study was first reported from Munich, West Germany, and is calculated from standard histologic sections by multiplying the MM thickness in millimeters (Breslow method) by the number of MM mitoses per square millimeter. A PI value of less than 19 versus greater than or equal to 19 was found to be a significant and independent prognostic variable for Stage I MM when compared with seven other predictive variables (including Breslow thickness). These PI intervals identified a subgroup of patients with MM of intermediate thicknesses (1.50-3.49 mm) whose significantly worse survival would not have been anticipated if prognosis were determined by Breslow thickness alone. For example, patients with MM 1.50 to 2.49 mm thick have a 5-year survival rate of 84.1% determined by Breslow thickness alone; however, among these patients exists a subgroup with PI greater than or equal to 19 whose survival rate is only 57.6%. This study verifies the additive usefulness of the PI in predicting survival rates of patients with Stage I cutaneous MM

Characteristics associated with familial compared with nonfamilial malignant melanoma were assessed. These data were obtained from consecutive prospectively completed questionnaires on 1169 cases of cutaneous malignant melanoma. Of these, 69 patients indicated a positive family history for this cancer. Among the various clinical and histological variables compared, those that significantly correlated with the familial occurrence of malignant melanoma include younger age at first diagnosis, smaller diameter of the lesion, lower Clark level, decreased frequency of nonmelanoma skin cancer, and reduced prevalence of noncutaneous cancer. Increased awareness of malignant melanoma among family members could account for some of these observations. Identification of the familial variety of malignant melanoma has practical implications concerning early detection and prompt intervention

Computer technology has advanced rapidly over the past 30 years as the computer has been more and more integrated into the practice of medicine. Current horizons of research have begun to make use of this newer technology in 1986. The numerous amounts of change and advances in computer systems with respect to medicine and specifically to dermatology will make the computer even more of an integral tool for the practice of this specialty in the future

This article highlights the process that a physician should undertake in selecting and implementing a business computer system for the office. Included are suggested approaches to identifying needs, establishing priorities, and communicating requirements to prospective vendors. Methods for reviewing various systems to evaluate whether they meet the practice's defined requirements are suggested

In 104 consecutive Caucasian patients who had histologically proved dysplastic nevi, the number and diameter of nevocytic nevi were determined in two equally sized contiguous rectangles in the lumbosacral region. The cephalad (superior) rectangle was in a relatively sun-exposed site, whereas the caudad (inferior) rectangle was in a relatively sun-protected site. Many of the nevocytic nevi identified in these rectangles had the clinical features of dysplastic nevi. Significantly, more nevi were found in the cephalad rectangle compared with the caudad rectangle. Men greater than or equal to 40 years of age had significantly larger nevi in the cephalad rectangle compared with the caudad rectangle. These data are consistent with the hypothesis that sunlight promotes development of more and larger nevocytic nevi in individuals afflicted with dysplastic nevus syndrome

Hazard-rate analysis provides a unique means of assessing prognosis in patients with malignant disease. The hazard rate is the probability of a patient dying within a particular unit of time after definitive therapy. Hazard-rate analysis was performed on a series of 719 consecutive patients with clinical stage I cutaneous malignant melanoma (MM). The peak hazard rate for death from metastatic MM occurred during the 48th month of follow-up. Thereafter, the hazard rate declined and approached zero by the 120th month. When the patients were stratified by the thickness of their primary MM, thicker lesions reached their peak hazard-rate month earlier than thinner lesions. We conclude that after 120-month survival, the risk of dying from MM is virtually zero. However, since rare late deaths from MM occur, lifetime follow-up is recommended

Stage I cutaneous malignant melanomas between 0.76 and 1.69 mm thick (Breslow measurement) in BANS (upper part of the back, posterior aspects of the arms, posterior and lateral aspects of the neck, posterior aspect of the scalp) areas have been reported to portend a relatively poor prognosis compared to non-BANS sites. We were unable to confirm the 15% poorer survival for BANS area lesions (84% BANS, 99% non-BANS) originally reported. In this report of 211 patients, malignant melanomas in BANS sites had a 4.6% poorer 5-year cumulative survival rate (88.9% BANS, 93.5% non-BANS; p = 0.35). Although many more patients need to be studied, we believe this small difference in survival is insufficient to influence therapeutic management strategies

With the rate of melanoma increasing 1,000% in the past 50 years, the early detection of the disease is becoming more important. Data from 2,239 persons seen at the Manhattan Melanoma/Skin Cancer Detection Screening Program were analyzed to determine if a complete cutaneous examination would significantly increase the chance of detecting melanoma. Thirteen of the fourteen melanomas detected were on anatomic sites normally covered by clothing. Patients having complete skin examinations were 6.4 times more likely to have a melanoma detected than those having partial examinations (p = 0.025). These findings reinforce the importance of complete skin examination for the early detection of malignant melanoma