Treatment of Malignant Melanoma—A Review of 111 Cases

In a study of 110 patients with 111 malignant melanomas, the most important factors in determining the ultimate prognosis were: the sex of the patient, the site of the lesion and the clinical stage of the melanoma at the time initial treatment was carried out. When there was no spread beyond the primary area, the five-year survival rate was 64%. Excisional biopsy is preferable even though the dangers of incisional biopsy may have been overestimated in the past. The value of prophylactic lymph node dissection has not yet been unequivocally proved. The rationale for isolated perfusion therapy in the treatment of malignant melanoma is sound; nevertheless, the effect of this adjunct on survival and cure must await future critical analysis.     

Lentigo Maligna and Malignant Melanoma

Lentigo maligna, a precancerous lesion, is a brown-black irregularly pigmented freckle, usually occurring on the face of the elderly subject. In a series of 99 patients with malignant melanomas, lentigo maligna was the pre-existing lesion in 21. The clinical and histological findings, and previous publications on the subject are reviewed. Lentigo maligna itself is not a superficial malignant melanoma. After the development of malignant melanoma from lentigo maligna, eight of 21 patients developed metastatic disease. This seems to indicate that once malignant melanoma has developed (whether de novo from the junctional portion of a pre-existing nevus, or from a lentigo maligna), the outlook is the same. During the development of malignant melanoma from lentigo maligna there is an indefinite period when it is virtually impossible to determine histologically whether malignant melanoma is present. Naturally, the inclusion of these indefinite cases will greatly influence reported results of treatment.     

Paradox of ras Oncogenes in Malignant Melanoma

Our studies over the past several years have concentrated on the role of oncogenes in the pathogenesis of malignant melanoma. Our objectives have been i) to determine the status of oncogene and proto-oncogene activation and expression during specific clinically defined stages of melanoma; ii) to determine if these genes are involved in the induction, maintenance, and/or metastatic potential of melanoma cells; iii) to decipher the relationship of neoplastic transformation to differentiation in this disease; and iv) to determine the nature and timing of specific events which disrupt the normal functioning of the melanocyte. The experiments are intended to test the concept that multiple, cooperating, independently activated oncogenes are involved in the evolution of malignant melanoma. The range of data we have accumulated to date suggests a definite, but complex, role for oncogenes in the development of melanoma and points to a probable interrelatedness of melanocyte-melanoma cellular differentiation programs and the process of malignant transformation. Further, our research has detailed a specific sequence of transformation-related biological and biochemical events occurring in vitro in the human melanocyte in response to ras oncogenes, and has generated information suggesting the presence of, as yet, undefined genetic elements in melanoma. Our work has evolved along a broad front, and we have analyzed the status of a large series of oncogenes in a range of melanomas and related tissues. However, in this brief review we will limit our focus to the ras gene family and discuss the data from my group and others which suggests not only a complex role for ras oncogenes in the etiology of melanoma but also a paradoxical one.     

Viewing Malignant Melanoma Cells as Macrophage-Tumor Hybrids

Cutaneous malignant melanoma (CMM) begins in the epidermis as the clonal emergence of melanocytes having a deregulated mitotic cycle. In a manner not yet understood, some descendents of these cells loosen their adhesions in situ and migrate into the dermis, thus initiating the processes of invasion and metastasis. These cells look and act much like macrophage-melanoma hybrids created in the lab or arising in mice. But genetic proof for hybrids in human melanoma is still lacking. Nonetheless, should tumor cell hybridization account for the invasive phenotype, this would surely evoke new therapeutic approaches regarding mechanisms of cell fusion and hybrid-specific molecular signatures. Here are described some of the remarkable phenotypic similarities between experimental macrophage-melanoma hybrids and CMM. The results suggest that invasive and metastatic CMM might well arise through fusion and genomic hybridization between melanoma cells and migratory bone marrow-derived cells.Key words: tumor cell fusion, tumor macrophage hybrid, melanoma, metastasis, melanin, migration, adhesion, β1,6-branched oligosaccharides     

黑色素瘤的治疗新进展

黑色素瘤的遗传学特性颇具代表性,常作为肿瘤研究的首选。本文对黑色素瘤发病的分子机理研究与基因治疗新进展作综述。     

Comparative Histopathology of Grey‐Horse‐Melanoma and Human Malignant Melanoma

Equine melanoma shows striking features particularly with regard to clinical development in grey horses: in contrast to malignant melanoma in humans and in solid coloured horses that are characterized by early onset of metastasis, pigment cell tumours display almost benign clinical features in ageing grey horses. Through evolution, grey horses appear to be in a favourable position in regard to the biological behaviour of melanomas. Yet unknown factors inhibiting or retarding early melanoma metastasis may be responsible for this phenomenon. In this study, immunostaining profiles and histopathologic patterns of equine vs. human melanotic tumours were compared. In addition, the expression of melanoma markers currently used in human melanoma detection and characterization were evaluated for their applicability in equine melanoma diagnosis. Immunohistopathologic investigations revealed that benign grey horse melanomas share common features with human blue nevi and with human malignant desmoplastic melanomas, whereas their resemblance to other types of human cutaneous malignant melanomas is less pronounced. Our data equally underline that S‐100, proliferating cell nuclear antigen (PCNA), HMB‐45, Ki‐67, T‐311 and CD44 can serve as reliable markers for horse melanomas. Further investigations aiming at identifying factors retarding metastasis in affected grey horses are needed, as they may contribute to the development of novel treatment strategies for human malignant melanoma.