Faculty Bibliography

Multiple factors appear to influence survival in patients with malignant melanoma. Although at present thickness appears to be the best individual prognostic factor, other variables such as anatomic site of the lesion, ulceration, and level consistently appear in multivariate prognostic models. These multivariate models enable the assessment of patient prognosis for the optimization of treatment as well as the evaluation of future therapeutic trials. Future study of these prognostic factors will hopefully help us to understand the pathophysiology of melanoma and, possibly, unlock the secrets of the biology of this disease

The clinical diagnosis of malignant melanoma requires the following: an acceptance of the concept of 'in situ' malignancy, both clinically and histologically; a high index of suspicion concerning any pigmented lesion; recalling the mnemonic 'remember your A,B,C,D's'; and a knowledge of the clinical simulators of malignant melanoma. Prevention of death from malignant melanoma is possible through early diagnosis and prompt treatment of thin lesions (less than 0.76 mm in thickness). Such lesions have an excellent prognosis. This goal can be reached by carefully designed and implemented professional and public education programs such as those that have been introduced in Australia, West Germany, and the United States. Currently, new programs are being developed jointly by the American Academy of Dermatology and the American Cancer Society that are aimed at promoting self-examination of the skin as an adjunct to a routine physician examination as an additional means of detecting malignant melanoma at a time when it is wholly curable

Although both dysplastic and congenital nevi appear to have a greater-than-expected risk for evolving into malignant melanoma, the magnitude of that risk is uncertain. For this reason, the management of patients with these lesions remains controversial. The National Institutes of Health Consensus Conference guidelines are presented with specific recommendations for the management of patients

The dysplastic nevus has not only been considered to be a 'marker,' but also a formal 'precursor' of malignant melanoma. Therefore, these lesions are important to recognize clinically. This article presents a classification of the dysplastic nevus based upon its variable clinical presentations. It is hoped that this classification will assist the physician to recognize many of the clinical variants of this unusual melanocytic nevus and, thus, to identify patients at greater risk for the development of malignant melanoma

The prevalence of congenital-nevus-like nevi (CNLN) in a group of 105 adults who had malignant melanoma (MM) was compared with that in a control group of 601 adults not afflicted by MM. Total cutaneous examinations were performed on both groups. The control group presented with complaints other than pigmented lesions. In this series, 10 (9.5%) of the group with MM had clinically diagnosed CNLN 1.5 cm or larger in diameter. These CNLN were not in contiguity with the MM sites. The 9.5% prevalence of CNLN in the group with MM was significantly higher (p less than 0.005) than the 2.5% CNLN observed in the control population. None of the patients in either group had large congenital nevocytic nevi (greater than or equal to 20 cm). In addition, in the group with MM, 5 patients (4.8%) had nevi spili (NS) and 13 (12.4%) had cafe-au-lait spots (CLS). The prevalence rates for these two types of pigmented lesions were not significantly different from those observed in the nonmelanoma control group (2.3% for NS; 13.8% for CLS). The relative risk for developing MM is 4.1 in people with CNLN compared with those without CNLN, which indicates that these nevi may be markers for individuals prone to develop malignant melanoma

In this article, a strategy for evaluating your practice in terms of its potential for computerization has been outlined. The rules that have been presented are general guidelines and exceptions may exist in any practice due to its specific needs. The use of a medical office computer consultant may help you to make this evaluation in a more effective manner. Once you have determined that your practice may benefit by the use of a computer, the next step is to select between the myriad of currently available systems. The next article in the series will be devoted to describing a method to help you select the system most appropriate for your setting