Selection of the optimum surgical treatment of stage I melanoma by depth of microinvasion: Use of the combined microstage technique (Clark-Breslow).

The methods of histologic staging of primary Stage I melanoma and the relation to lymph node metastases and survival after surgery was evaluated in 151 patients with extremity melanoma only. Microstaging by depth of invasion showed a better prognostic correlation than by histologic typing (into superficial spreading, or nodular melanoma). A correlation existed between depth of invasion (Clark's levels) and incidence of nodal metastases at elective node dissection.

Tumors of the liver as demonstrated by angiography, scan and laparotomy.

One hundred and eighteen patients with various hepatic tumors proved by laparotomy have been analyzed for accuracy and for pitfalls of preoperative studies, namely, physical examination, celiac and superior mesenteric angiography and liver scan. Angiography is correct in detecting a hepatic tumor in 93 per cent and scan, in 87 per cent, overall. When angiography and scan are combined, tumors are detected in 97 per cent of patients.

Spntaneous perforation of the gastrointestinal tract in patients with cancer.

The mortality of spontaneous gastrointestinal perforation in 36 patients with cancer was 84% (30 patients). The main factors responsible for this included failure of recognition, perforation through tumor, advanced uncontrolled disease and multiple organ failure. Six of 19 patients who underwent surgery survived (32%).

Intraoperative physiologic monitoring and management during hepatic lobectomy using the liver isolation-perfusion technic.

The high operative mortality of major hepatic resection for tumor can be improved by a technic of resection using complete vascular isolation and hypothermic perfusion of the liver. Complete clamping of the portal vein, vena cava, and hepatic artery was necessary and well tolerated. Major physiologic, biochemical, and coagulation changes, however, can occur with this technic that requires close monitoring by the anesthesiologist.

En bloc resection of primary melanoma with regional lymph node dissection.

En bloc resection of the primary melanoma with the regional lymph node drainage basin as a method of controlling disease within the area was used in 281 patients with stage I or II melanoma arising on the extremities (proximal to wrist or ankle) or on the trunk from 1954 through 1964. The en bloc operation was performed in 212 patients with a five-year cure of 73.5% (156 of 212).

Current management of hepatic tumors.

Today, the presence of a hepatic tumor can be diagnosed with considerable accuracy by means of isotope scans, arteriogram and ultrasonic imaging. Its localization to one lobe or other lobes is also generally achievable but with less accuracy because it is not yet possible to visualize the interlobar fissure by a noninvasive technique. Exploratory laparotomy with a view to resection is the preferred approach if the patient is in good general condition.

Malignant melanoma of the extremities: a clinicopathologic study using levels of invasion (microstage).

A clinicopathologic study was done in 151 patients with malignant melanoma of the extremities who were surgically treated in Memorial Hospital and had 5-to 9-year followup. Microstaging was done according to the depth of invasion, as determined by Clark's levels as well as by direct measurement. This was related to treatment and to clinical course.

Major hepatic resection using vascular isolation and hypothermic perfusion.

The technique and results of 29 major hepatic resections using the method of complete vascular isolation and hypothermic perfusion of the liver are reported. The method enables the surgeon to perform otherwise difficult or impossible resections through chilled bloodless hepatic parenchyma. Major intrahepatic vascular structures can thus be recognized and controlled readily under clear vision.