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Surgical margins for removal of dysplastic nevi
Rigel DS; Friedman RJ; Kopf AW
ORIGINAL:0005560
ISSN: 0148-0812
CID: 62472
Malignant melanoma in World War II veterans
Brown J; Kopf AW; Rigel DS; Friedman RJ
In a consecutive series of 1,067 patients entered into the data base of the Melanoma Cooperative Group at New York University School of Medicine between 1972 and 1980, 120 men were of draft age (18-31 years) during World War II (1941-1945). Questionnaires were sent to these 120 individuals; 89 responded. Simultaneously, a control (nonmelanoma) population of 65 men of similar age was queried. Each subject in both groups was asked whether he had served in the armed forces during World War II and, if so, what were his theaters of operation. Based on the response, 83% (74 of 89) of the melanoma group compared with 76% (49 of 65) of the control group had served in the armed forces during World War II; however, a significantly (p = 0.0002) greater percent of the melanoma patients (34%) served in the tropics than did the control subjects (6%). Further, overrepresented in the melanoma group that served in the tropics (compared with the melanoma group who served in the armed forces in nontropical theaters) were malignant melanomas that had their origin in nevocytic nevi. The findings suggest that Caucasian individuals heavily exposed to sunlight in the tropics for several years during early life may be at higher risk to the subsequent development of cutaneous malignant melanoma. In some individuals this may be a two-step phenomenon, in which the first step is the solar induction of nevocytic nevi and the second is malignant transformation within them
PMID: 6526560
ISSN: 0011-9059
CID: 16853
Is the Unsuit unsuitable? [Letter]
Rigel DS; Kopf AW; Greenwald DI; Levine LJ; Friedman RJ
PMID: 6738614
ISSN: 0028-4793
CID: 16854
"Microscopic satellites" are more highly associated with regional lymph node metastases than is primary melanoma thickness
Harrist TJ; Rigel DS; Day CL; Sober AJ; Lew RA; Rhodes AR; Harris MN; Kopf AW; Friedman RJ; Golomb FM; et al.
A multivariate analysis was performed on 20 clinical and histologic variables from 327 Stage I prospectively studied melanoma patients who underwent elective regional lymph node dissection (ERLD). Primary tumor thickness, microscopic satellites, and the elapsed interval between diagnosis and ERLD, were selected as the combination of variables that were most highly associated with clinically occult regional lymph node metastases (P = 10(-15), model chi-square). Microscopic satellites were defined as tumor nests, greater than 0.05 mm in diameter, in the reticular dermis, panniculus, or vessels beneath the principal invasive tumor mass but separated from it by normal tissue on the section in which the Breslow measurement was taken. The probability of finding nodal metastases for melanomas less than 0.75 mm thick was 0% (0/41 patients); for those 0.76-1.50 mm, 4% (4/108); 1.51-3.0 mm, 14% (14/102); and greater than 3.0 mm, 39.5% (30/76). Primary melanomas greater than 1.50 mm thick with microscopic satellites were more often associated with nodal metastases than those of similar thickness without satellites (30/57 (53%) versus 14/121 (12%), P = 0.01). Some satellites probably represent intraspecimen metastases, while others do not. Any predictive model for occult regional lymph node metastases based on data from ERLD done less than 50 days after diagnosis may underestimate the prevalence of metastases
PMID: 6704906
ISSN: 0008-543x
CID: 16855
Is it time for a computer in your practice? IV. Which practices benefit?
Rigel DS
PMID: 6643815
ISSN: 0148-0812
CID: 16856
Relationship of fluorescent lights to malignant melanoma: another view
Rigel DS; Friedman RJ; Levenstein MJ; Greenwald DI
In an attempt to determine whether exposure to fluorescent lights may cause an increased risk for developing melanoma, 114 patients with melanoma were compared to 228 age-matched controls. Fluorescent-light exposure, along with 10 other risk factors, was analyzed for its possible relationship to malignant melanoma. No association was found between fluorescent-light exposure and increased risk for acquiring malignant melanoma
PMID: 6619386
ISSN: 0148-0812
CID: 16857
Effect of anatomical location on prognosis in patients with clinical stage I melanoma
Rogers GS; Kopf AW; Rigel DS; Friedman RJ; Levine JL; Levenstein M; Bart RS; Mintzis MM
A study of the influence of the anatomical location of malignant melanoma on the prognosis of 971 patients with stage I disease disclosed specific high-, intermediate-, and low-risk sites. High-risk sites included scalp, mandibular area, midline of trunk (anterior and posterior), upper medial thighs, hands, feet (except the arches), popliteal fossae, and genitalia. The life-table-adjusted five-year disease-free survival was 54% in the high-risk locations, 79% in intermediate-risk locations, and 93% in low-risk sites. A Cox proportional hazards analysis demonstrated that the grouping of lesions by their anatomical risk location had prognostic value that was significant in a model of eight other known predictive variables (thickness, sex, age, type, level, mitotic index, ulceration, and presence of preexistent nevus). The results indicate that anatomical location of the primary melanoma is significantly associated with five-year disease-free survival
PMID: 6870318
ISSN: 0003-987x
CID: 16624
Local and in-transit metastases following definitive excision for primary cutaneous malignant melanoma
Roses DF; Harris MN; Rigel D; Carrey Z; Friedman R; Kopf AW
A total of 672 consecutive patients with clinical stage I and stage II primary cutaneous malignant melanoma were treated by excision of 3.0 to 5.0 cm of surrounding skin down to and including the underlying fascia when the lesion exceeded 0.5 mm thickness (Breslow measurement). More conservative margins were taken in locations where such excisions would result in significant cosmetic or functional morbidity and for thinner lesions (less than 0.5 mm). Seven of 658 patients with clinical stage I disease (1.1%) and three of 14 patients with clinical stage II disease (21.4%) developed histologically verified local metastases within 5 cm of the primary excision scar or skin graft. Fifteen patients with stage I disease developed in-transit metastases (2.3%) at a site more than 5.0 cm proximal to the surgical scar or skin graft but not beyond the regional nodal group. Two patients with stage II disease who had developed local metastases also developed in-transit metastases (14.3%). No patient with a lesion less than 1.0 mm thick has had a local recurrence. Nine of the ten patients (90%) who developed local metastases and 12 of the 17 patients (70.6%) who developed in-transit metastases have also developed systemic metastases to date. Local and in-transit metastases following such definitive excision is a significant indicator of disseminated systemic metastatic melanoma
PMCID:1352934
PMID: 6859994
ISSN: 0003-4932
CID: 25134
Predictors of late deaths among patients with clinical stage I melanoma who have not had bony or visceral metastases within the first 5 years after diagnosis
Day CL; Mihm MC; Sober AJ; Harris MN; Kopf AW; Fitzpatrick TB; Lew RA; Harrist TJ; Golomb FM; Postel A; Hennessey P; Gumport SL; Raker JW; Malt RA; Cosimi AB; Wood WC; Roses DF; Gorstein F; Rigel D; Friedman RJ; Mintzis MM
PMID: 6863649
ISSN: 0190-9622
CID: 16625
Favorable prognosis for malignant melanomas associated with acquired melanocytic nevi
Friedman RJ; Rigel DS; Kopf AW; Lieblich L; Lew R; Harris MN; Roses DF; Gumport SL; Ragaz A; Waldo E; Levine J; Levenstein M; Koenig R; Bart RS; Trau H
In a clinicohistopathologic study of 557 patients with primary cutaneous malignant melanoma, there were fewer metastases and/or deaths from melanoma when histologic evidence of a coexisting acquired melanocytic nevus was found. A total of 130 patients with melanocytic nevus and 427 cases of melanoma without histologic evidence of a nevus (denovo) were studied. Clinical follow-up evaluation for evidence of metastases and/or death was obtained. Only ten of the patients (7.7%) with nevus-associated melanoma had metastases and/or death v 78 (18.3%) with de novo melanoma. When stratified by lesion thickness, the logrank test for survival revealed a statistically significant difference between the two groups. An overall favorable outcome seen in patients with malignant melanomas associated with acquired melanocytic nevi was found, therefore, to be independent of lesion thickness as well as six other variables reported to be related to the biologic behavior of malignant melanoma. Thus, the presence of nevus cells in a specimen of malignant melanoma portends a better prognosis and may have important implications in the biology of this neoplasm
PMID: 6859885
ISSN: 0003-987x
CID: 16858