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Total remission of a conjunctival melanoma after contact radiotherapy
S308
Puskw - Skiercuncer
Five Caucasian patients (1 male/4 female) aged between 8-19 years were detected. The localization of MM was diverse. A pigmented previous lesion which increased in volume and bled was noted by 4 patients. Three tumours were polipoid. Four MM were classified as superficial spreading and one as nodular in microscopic study. Reticular dermis was invaded in 4 cases and thickness was z-4 mm in 4. Nodal and/or visceral metastases were detected in 3 patients. Surgery was performed in all, and chemotherapy in 2. All patients are alive, 3 months to 5 years after diagnosis. MM was particular agressive in our cases. The small number of patients and the short time of follow-up are obstacles to compare the MM evolution with that of the adult population. I P520
Total remission of a conjunctival melanoma after contact radiotherapy
F. Berard, 0. Pellissier de Feligonde. M.H. Koeb. J.P. GCrard. Hopital de 1‘Anriquuille, et Centre Irospitolier Lyon Sml. Lyon, France A 82 year-old woman attented in October 1990 for a conjunctival ulcerated melanoma (right eye) measuring 13 mm in diameter. She was also presenting a severe cardiac insufficiency, contraindicating surgical cure of the melanoma. There was no other melanoma lesion and no metastasis was found. We delivered a contact radiotherapy (4800 rads in 8 courses and a 600 rads boost on the tumor) from October the 10th to December the 19th. Immediate tumor size reduction was observed. At the end of March 1991. the lesion was unpalpable, and total remission was still observed in August 1994. The patient died at the end of 1994 from cardiac complications. Conclusion: Contact radiotherapy may be useful to treat melanoma in difficult location in old patients. I P521
Efficacy of the methods for detection of recurrencies and metastases in melanoma
P. Gil, F.J. Vgzquez-Doval, I. De Felipe, I. Sfmchez-Carpintero, T. Solano, A. Resano, M. Montalbetti, M.J. Garcia Velloso. E. Quintanilla. Deportament of Dermnrology, Clhico Universitoria de Nnvarra, Pamplona, Spain
Introduction: The real efficacy of the methods employed to detect the melanoma metastaseslrecurrencies is not well established. Patients and Methods: We have performed a retrospective analysis of 180 patients with melanoma treated in our department in the period 1980-1997. in search of those that have presented with a metastasis/recurrency, and its respective method for detection. Results and Conclusions: 60% of patients developed recurrencieslmetastases, being regional lymph nodes, local recurrenties and metastasis in transit, the most common places affected. Physical exam was the most liable method for detection of metastases/recurrencies. Chest radiographs and abdominal ultrasounds are less sensible compared to TAC-Scan and magnetic resonance for the detection of systemic metastases and PET shows a bigger sensibility and specificity. But the efficacy of these methods depends upon the frequency with which they are performed.
IP522
Recurrences in a group of 249 melanoma
C. Lok, E. Carmi, P. Esquenet, V. Viseux, M.D. Ciabrini, M.P. Di Cesare, F. Cauro, J.F. Poulain, J.P. Denoeux. Hopiral Sud. CHRU 80054 Amiern cedex I, Frcrtlce 249 patients with melanoma were followed in our unit between 1985 et 1996 including, at the diagnosis, 231 localized melanoma stage I and IIa with a Breslow thickness 2.42 f 2.1 mm and a Clark III-IV, 7 stage IIb (lymph node) and 11 patient stage III. Stage I (and IIa) patients had a clinical examination every 3 months, radiologic tests every 6 months. The mean follow-up was 28 f 21 months. Stage II patients had clinical examination every I.5 month and radiologic tests every 3 months. 43 patients stage I developpeg a regional lymph node metastase. 42 patients developped a distant metastase which was clinically asymptomatic in 26 cases, discovered on radiologic tests (CTscan mainly), and symptomatic in 13 cases (not described in 3 cases). Comments on this retrospective study: Patients stage IIb: asymptomatic visceral metastases discovered on radiologic tests in 2/3 cases. This is interesting because of the developpement of video-assisted thoracic surgery allowing easy resection of distal metastatic or suspect lesion of the lung. I P523
Lymphatic mapping and sentinel lymph node biopsy (SLNE) in patients with malignant melanoma
J. Ulrich’, H.-J. Otto’, H. Gollnick’. ‘Dept. of Dermotoology; 2Dept. of Nuclear Medicirre, Otto-vowGlcericke University School of Medicirre, Magdehrg, Germany The value of elective lymph node dissection for melanoma patients with clinically uninvolved regional nodes remains controversial. However, it has been proposed that SLNE reliably identifies individuals with micrometastases, who are most likely to benefit from full node dissection. The aim of this study was to assess the percentage of positive lymph nodes in malignant melanoma (MM) with Breslow-thickness higher than 0.7 mm. Until March 1998 fifty-two consecutive patients with MM from a Breslow-thickness of 0.7 mm upward underwent SLNE. After Iymhoscintigraphic localization of sentinel lymh node (SLN) a hand held gamma-probe guided biopsy of SLN(s) was followed. The histopathological examination of SLN(s) was performed with serial sections stained by HE and immunohistochemistry. Only in cases of positive SNL(s) a radical dissection of the lymph node basin was performed. No major postoperative complications after SLNE were seen. The intra-operative search for SLN was successfully in 96% cases, 100% in the groin and 92% in the axilla. In 9 out of 52 (17.3%) evaluable patients micro-metastases identified. These nine patients had a MM with Breslow-thickness greather than 2.0 mm. Only two out of these patients had more positive lymph nodes than the SLN detected by radical lymph node dissection. SLNE allows the use of a minimally invasive procedure that will help decreqse morbidity and may also allow more accurate staging. With the SLNE we are able to select patients who most likely benefit from ELND. For these reasons, SNLE should be considered the standard of care.
Puskw - Skiercuncer
Five Caucasian patients (1 male/4 female) aged between 8-19 years were detected. The localization of MM was diverse. A pigmented previous lesion which increased in volume and bled was noted by 4 patients. Three tumours were polipoid. Four MM were classified as superficial spreading and one as nodular in microscopic study. Reticular dermis was invaded in 4 cases and thickness was z-4 mm in 4. Nodal and/or visceral metastases were detected in 3 patients. Surgery was performed in all, and chemotherapy in 2. All patients are alive, 3 months to 5 years after diagnosis. MM was particular agressive in our cases. The small number of patients and the short time of follow-up are obstacles to compare the MM evolution with that of the adult population. I P520
Total remission of a conjunctival melanoma after contact radiotherapy
F. Berard, 0. Pellissier de Feligonde. M.H. Koeb. J.P. GCrard. Hopital de 1‘Anriquuille, et Centre Irospitolier Lyon Sml. Lyon, France A 82 year-old woman attented in October 1990 for a conjunctival ulcerated melanoma (right eye) measuring 13 mm in diameter. She was also presenting a severe cardiac insufficiency, contraindicating surgical cure of the melanoma. There was no other melanoma lesion and no metastasis was found. We delivered a contact radiotherapy (4800 rads in 8 courses and a 600 rads boost on the tumor) from October the 10th to December the 19th. Immediate tumor size reduction was observed. At the end of March 1991. the lesion was unpalpable, and total remission was still observed in August 1994. The patient died at the end of 1994 from cardiac complications. Conclusion: Contact radiotherapy may be useful to treat melanoma in difficult location in old patients. I P521
Efficacy of the methods for detection of recurrencies and metastases in melanoma
P. Gil, F.J. Vgzquez-Doval, I. De Felipe, I. Sfmchez-Carpintero, T. Solano, A. Resano, M. Montalbetti, M.J. Garcia Velloso. E. Quintanilla. Deportament of Dermnrology, Clhico Universitoria de Nnvarra, Pamplona, Spain
Introduction: The real efficacy of the methods employed to detect the melanoma metastaseslrecurrencies is not well established. Patients and Methods: We have performed a retrospective analysis of 180 patients with melanoma treated in our department in the period 1980-1997. in search of those that have presented with a metastasis/recurrency, and its respective method for detection. Results and Conclusions: 60% of patients developed recurrencieslmetastases, being regional lymph nodes, local recurrenties and metastasis in transit, the most common places affected. Physical exam was the most liable method for detection of metastases/recurrencies. Chest radiographs and abdominal ultrasounds are less sensible compared to TAC-Scan and magnetic resonance for the detection of systemic metastases and PET shows a bigger sensibility and specificity. But the efficacy of these methods depends upon the frequency with which they are performed.
IP522
Recurrences in a group of 249 melanoma
C. Lok, E. Carmi, P. Esquenet, V. Viseux, M.D. Ciabrini, M.P. Di Cesare, F. Cauro, J.F. Poulain, J.P. Denoeux. Hopiral Sud. CHRU 80054 Amiern cedex I, Frcrtlce 249 patients with melanoma were followed in our unit between 1985 et 1996 including, at the diagnosis, 231 localized melanoma stage I and IIa with a Breslow thickness 2.42 f 2.1 mm and a Clark III-IV, 7 stage IIb (lymph node) and 11 patient stage III. Stage I (and IIa) patients had a clinical examination every 3 months, radiologic tests every 6 months. The mean follow-up was 28 f 21 months. Stage II patients had clinical examination every I.5 month and radiologic tests every 3 months. 43 patients stage I developpeg a regional lymph node metastase. 42 patients developped a distant metastase which was clinically asymptomatic in 26 cases, discovered on radiologic tests (CTscan mainly), and symptomatic in 13 cases (not described in 3 cases). Comments on this retrospective study: Patients stage IIb: asymptomatic visceral metastases discovered on radiologic tests in 2/3 cases. This is interesting because of the developpement of video-assisted thoracic surgery allowing easy resection of distal metastatic or suspect lesion of the lung. I P523
Lymphatic mapping and sentinel lymph node biopsy (SLNE) in patients with malignant melanoma
J. Ulrich’, H.-J. Otto’, H. Gollnick’. ‘Dept. of Dermotoology; 2Dept. of Nuclear Medicirre, Otto-vowGlcericke University School of Medicirre, Magdehrg, Germany The value of elective lymph node dissection for melanoma patients with clinically uninvolved regional nodes remains controversial. However, it has been proposed that SLNE reliably identifies individuals with micrometastases, who are most likely to benefit from full node dissection. The aim of this study was to assess the percentage of positive lymph nodes in malignant melanoma (MM) with Breslow-thickness higher than 0.7 mm. Until March 1998 fifty-two consecutive patients with MM from a Breslow-thickness of 0.7 mm upward underwent SLNE. After Iymhoscintigraphic localization of sentinel lymh node (SLN) a hand held gamma-probe guided biopsy of SLN(s) was followed. The histopathological examination of SLN(s) was performed with serial sections stained by HE and immunohistochemistry. Only in cases of positive SNL(s) a radical dissection of the lymph node basin was performed. No major postoperative complications after SLNE were seen. The intra-operative search for SLN was successfully in 96% cases, 100% in the groin and 92% in the axilla. In 9 out of 52 (17.3%) evaluable patients micro-metastases identified. These nine patients had a MM with Breslow-thickness greather than 2.0 mm. Only two out of these patients had more positive lymph nodes than the SLN detected by radical lymph node dissection. SLNE allows the use of a minimally invasive procedure that will help decreqse morbidity and may also allow more accurate staging. With the SLNE we are able to select patients who most likely benefit from ELND. For these reasons, SNLE should be considered the standard of care.