MALIGNANT MELANOMA

774 the skin, I mention that there is a very rare kind, which I call "black cancers ". I explain that although they are very rare they sometimes start in a black raised mole, and for that reason it is advisable for anybody with such a mole to consult their doctor as to whether it should be " cut out " but not treated by cautery or other means. You quote Ewing and Powell as saying this is bound to result in many unnecessary operations. Who is to judge that the removal of any individual mole was unnecessary, as nobody can make an accurate prognosis of the future behaviour of such a mole by looking at it ? The late Dr. Margaret Tod wrote1 that if a patient asks to have a mole removed he must be strongly advised to leave it alone, but that if he insists the operation must be as radical as if the lesion showed signs of active growth. Surely a simple excision together with a centimetre surround of healthy skin and fascia, should be sufficient. To wait until the mole shows rate drops to 25% does signs of active growth and the survival " not seem to be a good example of preventive medicine

small societies, such as the Consumers’ Association (whose recent assessment of baby foods is a model of fair scrutiny), more attention should be paid to the study of the social effects of

advertising. The business of advertising poses problems which are moral, philosophical, and religious, as well as economic and political. These deserve serious and detached consideration. Perhaps one of our home-made millionaires could be persuaded to found a university chair of sales resistance. He might prefer to call it by some other name, and so long as the professor were allowed to do his work in peace I should not quibble over his title. Upper Sydenham, London, S.E.26.

JOHN BURKINSHAW.

THE PHARMACEUTICAL PERSUADERS

SIR,-In

many ways your anonymous correspondent Aug. 19 has examined the industry-medical relationship thoughtfully and helpfully. It is certainly important that the physician in practice or in academic work fully

of

Cancer Information Oxford.

Oxford. Association,

understands the commercial nature and function of our industry. We are frequently surprised that some defenders of the profession see the need to remind their brethren so often of this obvious fact. But I am concerned that the constructive possibilities of this article will be buried by its cynicism and glaring distortions. On p. 423, your correspondent makes the that pharmaceutical advertising unqualified statement makes full use of " taking facts out of context and misapplying them." I am not so naive as to deny that this has happened. But your correspondent is grossly unfair in his blanket condemnation of pharmaceutical advertising on this score. Inquiry will confirm, I-am confident, that distortion and misquoting are the exception and not the rule.

SiR,—The following illustrates Sept. 9.

Next I challenge your correspondent to produce the pharmaceutical house organ that does, as he says, " attack, deride, dissuade, and perform any number of miracles of modern advertising." I am aware of many outstanding publications issued on a regular basis by or under the sponsorship of pharmaceutical firms and have yet to see examples of the abuse he cites. Finally, I urge your readers not to be misled by his allegation that " many, if not most, medical congresses are now organised and supported by the pharmaceutical industry." Many medical meetings are in a sense " supported " partially by revenue from pharmaceutical exhibits, but it is absurd to " imply that the firms " organise the meetings. Occasionally a drug firm will sponsor a meeting devoted to a field of research interest or to a particular compound under study, but rarely indeed is the sponsorship of such meetings in any way hidden. ’

In

short, I think your correspondent has let his rhetoric

And I do not believe there is for exaggeration and distortion between those in medicine and those in industry who wish-as we in the; United States most certainly do-to preserve a progressive, vigorous system of medical care free from Government domination.

run

away with his facts.

room

;

Smith Kline and French Laboratories,

Philadelphia, Pennsylvania.

F ROLL IZOLL G F. .. G. Director of Public Relations.

MALIGNANT MELANOMA SIR,-Although in 1959 there were only 381 deaths! from malignant melanoma in England and Wales, your. leading article of Sept. 9 opens up an interesting subjectL because so many of these cases (about 80%) have their

origin

in

In my

long-existing pigmented moles. lectures to the lay public when speaking of cancers of

some

MALCOLM DONALDSON.

case

may be of interest since it your leading article of

points raised in

A married woman of 45 (2-para) had a pigmented mole since birth on the left lower eyelid. She noticed in June, 1947, that it was getting slightly larger. She was referred to an ophthalmic surgeon who did a local excision and plastic repair. There was a recurrence at the operation site 4 months later, and on Dec. 22, 1947, a surgeon excised the small tumour together with the preauricular glands and subcutaneous tissues. She made a satisfactory recovery but a left facial palsy developed. She was seen periodically until 1950. She was next seen on Feb. 23, 1957, when she complained of a small swelling in the left epitrochlear region which was tender and painful. She had noticed it for about a week. It felt like an enlarged gland not attached to any of the muscle groups. There was no noticeable enlargement of the axillary glands. The patient was immediately referred to the special hospital where she was seen before. A left axillary and epitrochlear dissection was performed there on March 11. The pathological examination of the removed gland proved that it was a malignant melanoma. Three more small tumours appeared on Aug. 7 in the right loin, right scapular, and left gluteal regions. They were dissected at the same hospital on Aug. 12. They contained deposits of large pleomorphic, anaplastic, and hyperchromatic cells-an appearance consistent with metastatic deposits of malignant melanoma. She left hospital on Aug. 24. Two more small tumours appeared in the abdominal wall on Sept. 9 and the patient began to complain of persistent headaches, nausea, and vomiting. She developed diplopia on Oct. 2 and pain in the left shoulder and arm. She became gradually more and more unsteady. She was readmitted on Oct. 12, and became irrational, confused, and uncooperative, probably because of cerebral metastases. She died on Oct. 26.

It is

interesting that

a

mole which

was

benign

for

45 years suddenly developed malignant changes resulting in local spread only. This was probably caused by some

premenopausal hormonal activity.

Surgical dissection spread became more virulent, probably owing to a more intense postmenopausal hormonal activity which determined the increased malignancy. This sequence of events supports the view expressed in your leading article that a malignant melanoma may be in some degree hormone-dependent and that its prognosis is

halted its

10 years later the

spread. hsematogenous and

better in

women

London, S.E.25.

before than after the menopause. A. FRY. 1.

Lancet, 1944, ii, 532.