Early death from clinical stage I melanoma.

We studied 13 prognostic factors in 582 patients with clinical stage I melanoma to determine which factor or combination of factors was associated with death from melanoma within the first 24 months following diagnosis. Thirty-six patients died during this period. Only 2 deaths occurred in patients with primary tumors thinner than 1.

Multiple agminated spindle cell nevi: unique clinical presentation and review.

A boy with agminated spindle cell nevi is described. Present within the area of involvement were congenital nevocellular and composite spindle/nevocellular nevi. Other unusual features included a dynamic pattern of growth and regression of the lesions, with the presence of halo nevi and background café au lait pigmentation.

Methotrexate-induced necrolysis.

A 72-year-old woman with a long history of recalcitrant psoriasis developed severe generalized erosions after receiving low-dose (7.5 mg) methotrexate. Her clinical picture was consistent with toxic epidermal necrolysis and showed a gradual response to systemic steroids and topical therapy.

Increased intraepidermal melanocyte frequency and size in dysplastic melanocytic nevi and cutaneous melanoma. A comparative quantitative study of dysplastic melanocytic nevi, superficial spreading melanoma, nevocellular nevi, and solar lentigines.

Dysplastic melanocytic nevi (DMN) are distinguished histologically by a hyperplasia of variably atypical intraepidermal melanocytes in a lentiginous epidermal pattern. In order to further characterize the intraepidermal melanocytes of DMN, 4 representative specimens each of DMN, acquired nevocellular nevi (NCN), solar lentigines (SL), and superficial spreading melanoma (SSM) were selected on the basis of predetermined criteria, confirmed in a blind histologic assessment, and compared in a quantitative morphologic study using 6 micron-thick hematoxylin and eosin stained sections of L-dihydroxyphenylalanine (dopa) preincubated vertical tissue slices of lesion and adjacent normal skin. The average melanocyte frequency, expressed as the percent of dopa-reactive perikarya among 600 consecutive basal unit cells, was significantly greater in DMN (60 +/- 23%) than in NCN (18 +/- 3%), SL (25 +/- 7%), and adjacent skin (14 +/- 3%), but similar to that in SSM (71 +/- 11%).

Dermatologic manifestations of infection in the compromised host.

The skin occupies an important position in the prevention and evaluation of infection in patients who are immunocompromised. The skin can provide a portal of entry for both locally invasive and disseminated infection; and, not infrequently, skin lesions may be the first sign of disseminated infection from other primary sites. The first clinical principle in approaching this problem is that the skin must be protected from trauma, maceration, or alteration in its normal microbial flora.

Major histocompatibility antigens and mononuclear inflammatory infiltrate in benign nevomelanocytic proliferations and malignant melanoma.

The presence of major histocompatibility antigens in malignant melanoma and benign nevomelanocytic lesions and the nature of associated mononuclear inflammatory cells were studied in situ by using monoclonal antibodies and an immunoperoxidase technique. HLA-A,B,C (HLA) and beta 2-microglobulin (beta 2m) were found on malignant melanocytes in primary cutaneous and metastatic melanomas. In contrast, HLA antigens were not identified on nevomelanocytes in benign hyperplasia or nevocellular nevi, although in some cases faint staining for beta 2m was present.

Skin lesions suspected to be melanoma should be photographed. Gross morphological features of primary melanoma associated with metastases.

We reviewed photographs of 256 primary cutaneous melanomas to determine the gross morphological correlates of metastases. Seven and a half years after diagnosis, the melanomas with ulceration occupying at least 80% of their surface had the highest rate of metastases (85%), and melanomas without a nodule had the lowest metastatic rate (11%). Melanomas with nodules had a metastatic rate of 62%, and this rate increased in direct proportion to nodule diameter.

The surgical management of "in situ" melanoma.

The concept of melanoma "in situ" is discussed pointing out that these lesions have the potential to become invasive tumors if not adequately treated. If such a pathologic diagnosis is made, each margin of the specimen should be carefully checked for the presence of atypical melanocytes. In our experience, with excision margins of 0.

The malignant potential of small congenital nevocellular nevi. An estimate of association based on a histologic study of 234 primary cutaneous melanomas.

In order to assess a relationship between small congenital nevocellular nevi and cutaneous melanoma, histologic features commonly associated with congenital nevi were sought in 234 melanomas. The detection of one or more histologic features of congenital nevi in 8.1% (19/234) of melanoma specimens was directly related to the number of slides and tissue sections with melanoma available for review, the predominance of superficial spreading melanoma (SSM) and the historic relationship to a preexisting pigmented nevus at the tumor site.

A multivariate analysis of prognostic factors for melanoma patients with lesions greater than or equal to 3.65 mm in thickness. The importance of revealing alternative Cox models.

Fourteen prognostic factors were examined in 79 patients with clinical Stage I melanoma greater than or equal to 3.65 mm in thickness. All nine patients with melanoma of the hands or feet died of melanoma.

Prognostic factors for patients with clinical stage I melanoma of intermediate thickness (1.51 - 3.39 mm). A conceptual model for tumor growth and metastasis.

Fourteen variables were tested for their ability to predict visceral or bony metastases in 177 patients with clinical Stage I melanoma of intermediate thickness (1.51 - 3.39 mm).

Prognostic factors for melanoma patients with lesions 0.76 - 1.69 mm in thickness. An appraisal of "thin" level IV lesions.

Fourteen variables were tested for their prognostic usefulness in 203 patients with clinical Stage I melanoma and primary tumor 0.76-169 mm thick. Only two variables, primary tumor location and level of invasion, were useful in predicting death from melanoma for these patients.

Diffuse melanosis secondary to metastatic malignant melanoma. Light and electron microscopic findings.

Tumor-free hyperpigmented skin from a patient with diffuse melanosis secondary to metastatic melanoma was examined by light and electron microscopy. Our findings indicate that the pathogenesis of this diffuse slate blue color is primarily to pigment deposition within perivascular dermal macrophages. We did not find intact melanosomes or individual tumor cell metastases in clinically normal skin, as has been previously reported.

A prognostic model for clinical stage I melanoma of the trunk. Location near the midline is not an independent risk factor for recurrent disease.

Fifteen variables were studied for their usefulness in predicting recurrent disease in 254 patients with clinical stage I melanoma of the trunk. Thickness of the primary tumor correctly predicted outcome with an accuracy of 90 percent or greater in 176 patients with melanoma primaries with a thickness of less than 1.70 mm or 5.

Malignant melanoma. Prognostic significance of "microscopic satellites" in the reticular dermis and subcutaneous fat.

A review of the microscope slides of the primary tumors for 596 patients with clinical Stage I melanoma revealed that primary lesions displayed two distinct patterns of invasion: 1) single cell invasion with direct extension of the main body of tumor into the reticular dermis or subcutaneous fat, and 2) invasion with "microscope satellites" (i.e. discrete tumor nests greater than 0.

Drug- and heavy metal--induced hyperpigmentation.

Several categories of chemical and pharmacologic agents can cause alterations in cutaneous pigmentation, although the mechanisms differ and in several instances may be unknown. Fixed drug eruptions appear to have alteration of the basement membrane zone with incontinence of epidermal pigment as the mechanism of hyperpigmentation. Heavy metals produce increased pigmentation in part from deposition of metal particles and in part from an increase in epidermal melanin production.