Faculty Bibliography

In a prospective study of 178 patients with malignant melanoma, a subset of 33 patients (18.5%) was identified to be at significantly higher risk for developing metastatic disease based on history of cigarette smoking. Patients in this high-risk group (current smokers with a greater than 15 pack-years of smoking history) had two-year disease-free survival rates of 74.2%. versus 92.3% for the remaining patients (p = 0.008). A possible explanation of this phenomenon is that chronic smoking diminishes host defense mechanisms and results in an adverse affect on the biologic behavior of established malignant melanomas

Despite the high cure rate achieved for basal-cell carcinomas treated with microscopically controlled excision, recurrences do occur. To determine if lesions that are likely to recur may be predicted at the time of surgery, data from 5020 patients with 7010 basal-cell carcinomas treated with Mohs' technique were reviewed. Two thousand nine hundred sixty (2960) lesions with five-year follow-up were studied (overall recurrence rate = 2.6%). Sex and age of the patients, size and location of lesions, types of previous therapy, and the number of surgical stages of microscopically controlled excision were all found to correlate significantly with recurrence rate (p less than 0.01). Multiple regression analysis was performed to determine the relative contribution of each of these variables to predictability of recurrences by a weighted scoring system. The derived model delineated the lesions into no-risk, low-, medium-, and high-risk groupings (p less than 0.000001). Lesions in the high-risk group had a recurrence rate of 10.1%, almost four times greater than the average. More aggressive microscopically controlled excisions and closer follow-up care are indicated for those lesions that can be predicted to result in a high-risk score

From their experience in treating squamous-cell carcinomas by microscopically controlled surgery, the authors found that such lesions in men, particularly in young men, on the extremities and of sizes larger than 5 cm or requiring more than four stages of excision had highest recurrence rates. They recommend one more stage of excision beyond an apparent plane free of malignancy as an insurance in selected cases

A case of adenocarcinoma of the gallbladder associated with acanthosis nigricans and the sign of Leser-Trelat is presented. The significant underrepresentation of adenocarcinoma of the gallbladder in association with malignant acanthosis nigricans is noted. If malignant acanthosis nigricans is caused by an ectopic peptide, a relative lack of production of the postulated substance by gallbladder adenocarcinoma cells could account for this finding

Basal-cell carcinomas on covered, anatomically shielded, or otherwise unusual sites of the body are rare compared to the number on constantly exposed parts of the body, but since basal-cell carcinomas are so common, instances of the former sort are not infrequently encountered. Five such cases are described and illustrated

Malignant acanthosis nigricans is a dermatosis that appears grossly as a hyperpigmented, velvety, or verrucous hyperplasia of the epidermis, most marked in flexural areas. It is always associated with a malignancy. In 277 cases reviewed, the condition was associated with gastric carcinomas in 55.5%, with other intra-abdominal carcinomas in 17.7%, and with malignancies in other sites in 26.8%. Current theories for the association and pathogenesis of the cutaneous process are discussed