How I Survived Melanoma Skin Cancer

How To Prevent Skin Cancer

How To Prevent Skin Cancer

Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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How I Survived Malignant Melanom

By The Time You've Finished Reading How I Survived Melanoma Skin Cancer Seven Survivors Tell Their Stories. You'll Feel Like A New Person, with A New, More Positive Outlook! You will learn: 1. How do I know if I have melanoma? What are the signs and symptoms? I wanted to know why the doctor was so concerned when she looked at that little mole on my forearm. What was it that looked so sinister? How worried should I be? Was the doctor over-reacting? 2. What tests will the doctor carry out to see if I have melanoma? Will they be able to tell me on the spot if there is a problem? Or will I have to wait for days, fretting about whats going on? 3. How curable is melanoma? If they do tell me its melanoma, what exactly does that mean? Is it a death sentence? Will they tell me You have 12 months to live. Get your life in order and prepare for the worst.? 4. What are the stages of the disease? The reading Id done said that there were different stages of melanoma. What are the symptoms of each stage? What are the survival rates of each stage? If I had a later stage melanoma, wouldnt I know about it? Wouldnt I actually feel like I was sick? 5. How quickly does the disease progress or spread? Should I have gone to the doctor sooner? Id noticed the mole changing over about 3 months. Was this delay critical? 6. How is melanoma normally treated? Would I have to go through chemotherapy and radiation treatment? If so, for how long? What are the odds of curing the disease using these treatments? How extensive is any surgery likely to be? How big will the scars be? 7. What are the common side effects of the treatments? Would I lose my hair? Would I become sterile? What else could I expect? 8. What alternative treatments are available? Id heard of people going on special macro-biotic diets. Id seen lots of herbal remedies on the internet. Which of these are proven and documented, and which ones are snake oil? Is it possible to combine alternative treatments with surgical other western treatments? How do I find a doctor that is open to using both alternative and western treatments? 9. What are the latest treatments being developed, and who is carrying out clinical trials of these new treatments?

How I Survived Malignant Melanom Overview


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Management of Malignant Melanoma Localized to the Skin Stage I and II

In the recent past, several prospective studies have validated the use of conservative margins according to Breslow's depth (147-152). The NIH consensus was that in situ melanoma required 5 mm margins, < 1mm required 1cm margins, and > 1 mm required 2-3 cm margins. Veronesi recommended that melanomas < 2 mm deep could be treated with 1 cm margins. Balch recommended 2 cm for melanomas with Breslow's depth of 1-4mm. indications for MMS in melanoma include Approximately 20 of stage I and II melanomas will metastasize to regional lymph nodes within 3 years. Nevertheless, the risk is variable according to Breslow's-depth. Elective lymph node dissection (ELND) is not recommended for melanomas 1.5 mm or thinner because the risk for nodal disease is very low. Delayed therapeutic nodal dissection performed at the time of detection of clinical nodes is effective. ELND is likewise not recommended for lesions thicker than 4mm. Distantmetastasis, with or without nodal involvement, occurs in...

Comment on sunscreen use and melanoma risk

Some studies demonstrate a positive association between sunscreen use and risk for cutaneous melanoma whereas others do not. Many confounding factors prevented any firm conclusions as to the possible protective or harmful effect on the use of sunscreens. The most likely reason for an apparently increased risk is that individuals who use sunscreen stay in the sun longer because they falsely believe that sunscreen protects them. This needs further research, particularly to clarify knowledge and attitudes to suntanning, sunscreen use and knowledge of skin cancer. It would seem that individuals intent on gaining a suntan use sunscreens to give themselves more time in the The Nambour Skin Cancer Prevention Trial (a randomised study exploring risk of both SCC and BCC) demonstrated that sunscreen use could be significant in reducing the risk of SCC.44 This was a complex trial including 1850 residents aged 20-69. They were invited to use a daily application of SPF 16 sunscreen and use 30 mg...

Melanoma Biomarkershow To Find Them

Sample-based screening of melanoma tumors for desired markers can be performed with traditional immunohisto-chemistry (IHC) or with more sophisticated gene arrays, TMAs, or tumor protein lysate array. Melanocytes and melanoma cells in vitro and in tumor samples from different stages of melanoma progression have been studied widely by immunohistochemistry to identify specific proteins to be used as biomarkers for prognosis. Markers which have shown prognostic value in restricted patient groups include S-100B, melanoma inhibitory activity protein (MIA), tyrosinase, certain matrix metalloproteinases, integrins, interleukin-8, and CD 44 (Ref. 8 and references therein). Some of these markers can also be measured in patient sera. The increased expression levels or bioactivity of these markers is usually associated with melanoma progression, recurrence, or poorer survival. However, the clinical use of these markers is limited to oncology departments with research activity. In microarray...

Additional Melanoma Genes

Mutations in CDKN2A and CDK4 account for only 5-50 of melanoma families. Many families in which no genetic defect has been found show linkage to chromosome 9p. Recent advances in mutation analysis of the CDKN2A gene suggest that some of these families will harbor mutations in the noncoding regions of the CDKN2A locus. However, several studies (including haplotype and loss of heterozygosity analyses) provide evidence for a second melanoma susceptibility gene residing centromeric of CDKN2A. Considerable effort is being put into studies to identify other melanoma susceptibility genes. This effort has recently paid off with a publication showing convincing evidence for a melanoma susceptibility gene on chromosome 1p22. 20 Other nonreplicated linkage studies have

Melanoma Genetics

Altering the genetic message in cancer is essential for its development and can be caused by DNA mutations, chromosomal aberrations (CNAs), epigenetic modification, and protein-protein interaction. 1 Mutations in the genomic DNA can lead to alterations in gene expression and function. Multiple genetic alterations have been described during development and progression of cutaneous melanoma. 2 Investigation of primary melanomas by comparative genomic hybridization has resulted in detection of losses of chromosomes 6q, 8p, and 10 as well as increases in copy numbers of chromosomes 1q, 6p, 7, and 8. 2 DNA modification, mutation, and viral genome integration can lead to chromosomal instability, i.e., CNA, where particular regional amplifications and deletions of genes are found. Chromosomal aberrations have been found in genomes of multiple solid tumors. O'Hagan et al. 3 have been able to distinguish primary melanoma tumors with different etiology by using array-based comparative genomic...


Melanoma peaks at age 20-45 years, typically in fair-skinned persons with a history of severe sunburn. Other risk factors are past history of melanoma and family histories of melanoma and dysplastic naevi. Clinical types are superficial spreading melanoma, nodular melanoma and acral lentigi-nous melanoma (occurring in palm, sole, nail bed and mucus membrane). If possible, total excisional biopsy is preferred. Treatment is by surgical excision of skin and subcutaneous tissue with 1.5-3 cm of margin depending on the site and thickness of the melanoma. The best data available show no difference in outcome between removing the underlying fascia and not. Elective regional lymph node dissection is optional for tumour thickness over 1.5 mm. For lesions arising in the temporal or upper cheek area, total parotidectomy as well as neck dissection may be required to treat adequately regional nodal metastases. In recent years, sentinel node biopsy is increasingly accepted for melanoma over 1.5 mm...

Malignant Melanoma

The incidence of malignant melanoma is increasing, thus making consideration of this disease process important. Malignant melanoma of the foot accounts for up to 15 percent of all cutaneous melanomas. Melanomas can present as an atypical, pigmented, or nonhealing lesion of the foot, including the nail. These malignancies often imitate more common foot disorders such as fungal infections and plantar warts. Since prognosis is directly related to early diagnosis, a high index of suspicion must be maintained. All skin lesions that are either atypical or not healing despite treatment should be referred for biopsy. 2948

Metastatic Melanoma

Duodenal Bulb Radiology

Metastatic melanoma is by far the most common of these tumors to be encountered clinically, and it may be taken as a particular prototype. The hematogenous deposition is usually in the submucosal layer where it may be seen early as small mural nodules, and growth typically results in polypoid masses with a bulky extension Fig. 4-198. Metastatic melanoma to small bowel. Fig. 4-198. Metastatic melanoma to small bowel. Dissemination may be single (Fig. 4-208) but is more often multiple. Although metastatic melanomas may involve any portion of the alimentary tract, they tend to be more numerous and more frequent in the small bowel. In an autopsy series of 1,000 cases, secondary small bowel involvement was found in 58 .241 When multiple, they may be either widespread (Fig. 4-209) or confined to a segment of intestine (Figs. 4-198 and 4210). This reflects their mode and periodicity ofvascular distribution.1 Diffuse metastases are infrequently of different sizes (Fig. 4-209), indicating...

Extremely common disorders

Skin diseases are very common in the general population. Prevalence surveys have shown that skin disorders may affect 20-30 of the general population at any one time.16 The most common diseases are also the most trivial ones. They include such conditions as mild eczematous lesions, mild to moderate acne, benign tumours and angiomatous lesions. More severe skin disorders which can cause physical disability or even death, are rare or very rare. They include, among others, bullous diseases such as pemphigus, severe pustular and erythrodermic psoriasis, and malignant tumours such as malignant melanoma and lymphoma. The disease frequency may vary according to age, sex and geographical area. In many cases, skin diseases are trivial health problems in comparison with more serious medical conditions. However, as already noted, because skin manifestations are visible they cause greater distress than more serious medical problems. The issue is complicated because many skin disorders are not a...

Oncolytic Adenoviruses

Type II CRAds are adenoviruses where the expression of genes essential for adenoviral replication are under the control of a tumor-specific promoter. When this promoter is active, expression of this gene will result in replication of the virus. These promoters should mainly be active in tumor cells to ensure that replication predominantly occurs inside the malignant tissue. An example of a tissue-specific promoter is the prostate-specific antigen (PSA) promoter which is highly active in PSA-producing prostate cells and shows limited activity in other tissues. Placing a gene essential for replication directly under the control of the PSA promoter directs adenoviral replication primarily to prostate cells that express PSA. 6 Thus this adenovirus will replicate inside prostate (tumor) tissue while sparing the other tissues. At the moment, phase I and II trials are being conducted. Another example of a tumor-specific promoter is the telomerase promoter, which is active in more than 80 of...

Doublecontrolled Conditionally Replicating Adenoviruses

After the systemic administration of adenoviral vectors, most of the virus ends up in the liver. When adenoviral replication is not strictly restricted to certain cell types or tissues, severe liver damage might occur due to adenoviral replication and consequential lysis of the liver cells. Because of this importance to restrict adenoviral replication, solutions have to be found for the observed aspecific replication of CRAds. One solution is a double-controlled conditionally replicating adenovirus (dcCRAd). 8 In a dcCRAd not one but two replication essential genes are controlled by two tumor-specific promoters. For example, both the adenoviral E1A and E1B genes have been placed under the control of two different tumor-specific promoters. Also, studies have already been conducted with both the E1A and the E4 gene under control of two different tumor-specific promoters.1-9-1 E1A, E1B, and E4 are all examples of adenoviral genes that are essential for replication of the adenovirus. The...

Physical Examination 231

After vital signs and the initial assessment, the secondary assessment is conducted. If possible, the physical examination should be conducted in a systematic way in a fully exposed patient. In trauma patients, the risk of hypothermia must be considered even in the warmer months nevertheless, it should not hinder complete exposure for examination and it will be reduced bywarm infusions and by covering with external warming devices after assessment (ATLS Manual 2004a). With the exception of life-threatening emergencies requiring immediate evaluation and therapy, the secondary assessment should include organ systems other than those assumed to be affected. This will allow the discovery of physical signs not necessarily linked to the working hypothesis, as well as those arising from any additional disease (e.g., discovering a melanoma in a patient presenting with renal colic).

Chemical Carcinogenesis

One hundred and forty years after Dr. Pott's report of the association of soot from the combustion of coal with epidermal cancer of the scrotum, an experimental basis for Pott's clinical observation was reported. In 1915, the Japanese pathologists Yamagawa and Ichikawa described the first production of skin tumors in animals by the application of coal tar to the skin. These investigators repeatedly applied crude coal tar to the ears of rabbits for a number of months, finally producing both benign and, later, malignant epidermal neoplasms. Later studies demonstrated that the skin of mice was also susceptible to the carcinogenic action of such organic tars. During the next 15 years, extensive attempts were made to determine the nature of the material in the crude tars that caused malignancy. In 1932, Kennaway and associates reported the production of carcinogenic tars by pyrolysis of simple organic compounds consisting only of carbon and hydrogen (cf. Kennaway, 1955). In the early...

Age of Cancer Incidence

The sixth section examines the different patterns of incidence between the two sexes. Males have slightly more cancers early in life. From approximately age 20 to 60, females have more cancers, mainly because breast cancer rises in incidence earlier than the other major adulthood cancers. After age 60, during the period of greatest cancer incidence, males have more cancers than females, male incidence rising to about twice female incidence. The excess of male cancers late in life occurs mainly because of sharp rises in male incidence for prostate, lung, and colon cancers. Male cancers accelerate more rapidly with age than do female cancers for lung, colon, bladder, melanoma, leukemia, and thyroid. Female cancers accelerate more rapidly for the pancreas, esophagus, and liver, but the results for those tissues are mixed among samples taken from different countries.

The role of consumers

Consumer involvement has been a strong feature of the CSG from the very beginning. This is because skin disease greatly affects the quality of life of the individual and because much of the trial work in skin disease has been dominated by answering questions that are important to the pharmaceutical industry. Consumers help us to redress that imbalance. At present (Autumn 2002) the skin group has 55 groups working on topics, both common and rare, such as acne, alopecia, bullous pemphigoid, eczema, excessive sweating, psoriasis, skin cancer and vitiligo. About 30 active consumers are involved at many

Immunogenetic classification of cell surface diversity

Third, clonogenetic diversity is determined by somatic genetic changes in gene structure, such as mutations and recombinational events. Genetic recombination is a normal step in immunoglobulin (Ig) and T cell receptor (TCR) gene expression, whereas mutations due to hits by external mutagens or errors in replication may affect any surface antigen gene in somatic cells. Such changes will escape notice unless an affected cell undergoes clonal expansion. For example, malignant transformation of individual B cell or T cell clones has allowed serologic detection of clonotypic determinants on surface Igs and TCRs. The individually distinct tumor rejection antigens of chemically induced sarcomas of mice, the unique antigens of human melanoma detected by autologous typing, and the turn antigens of mutagenized mouse tumors may represent clonogenetic diversity of this sort on nonlymphoid cells. In the case of unique antigens of human melanoma, the serologic specificity has been traced to a...

Experimental Radiation Carcinogenesis

Although humans were the first experimental animals in which radiation-induced cancer was demonstrated, there are now many examples of the experimental induction of cancer by radiation. The experimental induction of skin cancer in mice by Findlay (1928) and later by Rusch

Back to the individual patient

What is the risk of extraspinal hyperostosis in a patient with psoriasis treated for several months with acitretin Does PUVA therapy increase the risk of non-melanoma skin cancer in a patient being treated for mycosis fungoides What is the chance of severe depression in an adolescent taking 13-c s-retinoic acid for acne To address these questions, physicians must effectively search for evidence and must be able to assess

Triumph of the aggregate

It is easy to misinterpret the application of aggregate data to individuals by equating group probabilities to individuals.10 Thus, if a trial of excisional surgery for melanoma showed that 95 of participants (similar to your patient) were clear from disease at 5 years, one cannot then tell your patient You have a 95 chance of being clear at 5 years with this treatment since this 95 refers to the group and not the individual. The patient in front of you will either clear or not clear - the patient's fate or response is already determined at that moment by that patient's microdisease and other cofactors such as immunological status, much of which may be under genetic influence. However, it is correct to tell that patient that 95 of people similar to you are clear at 5 years.

The problem of drug resistance

Some tumours are intrinsically resistant to chemotherapy for example, many carcinomas and malignant melanoma. Large, slow-growing tumours are also relatively resistant, owing to the low growth fraction. Tumour cells may also acquire resistance by mutation to a drug-resistant phenotype. Thus, a tumour that has previously been responding well to a particular drug may cease to respond. Various drug resistance mechanisms have been identified and are detailed for different drugs in Boxes 3.1-3.5. Multidrug resistance (MDR) is a phenomenon by which a tumour cell becomes resistant to multiple drugs, including some to which the tumour may not have been exposed. MDR can occur as a result of the expression of a membrane P-glycoprotein pump, which expels the drug from the cytoplasm, lowering the intracellular concentration of the drug so that the tumour cell survives. The vinca alkaloids and doxorubicin act as substrates for this pump.

Somatic PTEN alterations in sporadic tumours

Many other types of sporadic cancers have also been examined. For example, sporadic glioblastoma multiforme carries a relatively high frequency of somatic PTEN mutations as well as 'second hit' intragenic mutations or deletions (Rasheed et al., 1997 Wang et al., 1997 Durr et al., 1998 Maier et al., 1998). However, lower-grade gliomas were not found to be associated with PTEN mutations. It has now become obvious that PTEN may be inactivated by several different mechanisms, and not just somatic intragenic mutations. Several mechanisms of inactiva-tion can occur in a single tumour type, although the sense is that one particular mechanism predominates in any one tissue type. For example, in the endometrial neoplasia system, either two genetic hits, or one genetic hit and one epigenetic silencing hit, can occur, although the latter predominates. In malignant melanoma, both inactivating hits for PTEN are epigenetic (Zhou et al., 2000a). In contrast, PTEN might also be inactivated by...

Calcium and Vitamin D

Vigorous calcium deposition in children in the tropics and subtropics despite very low calcium intakes may relate to higher circulating 25 hydroxy vitamin D derived from the action of sunlight on 7-dehydrocholesterol in the skin and to high levels of physical activity amongst these children. Deposition of calcium in bone is significantly affected by the weight-bearing activity of the individual. Where children are less active and vitamin D levels lower, dietary calcium intakes may have a greater determining effect on bone mineralization. In northerly temperate climates, such as the UK, children's diets should provide a good source of calcium and there should be reasonable exposure to summer sunshine (a slightly controversial area in view of current concerns about increased skin cancer risk from UVL). An active lifestyle is also important for optimal bone mineralization and high PBM, particularly in those where there is reason to suspect genetic predisposition to low PBM.

Effects Of Cbt Interventions On Health Outcome

To date, few studies, regardless of the theoretical orientation on which the psychosocial intervention is based, have addressed this question directly. One example involves the investigation conducted by Fawzy and his colleagues (1993) with malignant melanoma patients noted previously. Although this study was not originally designed to specifically assess differences in survival rates as a function of differing treatment conditions, this research team did find 6 years later that the CBT group experienced longer survival as compared to control participants, as well as a trend for a longer period to recurrence for the treated patients.

Malignant Complications of Celiac Disease

The second most common malignancy occurring in celiac disease is that of adenocarcinoma of the small intestine. This adenocarcinoma seems to occur in the setting of the chronic inflammation of celiac disease. It is associated with defects and mismatch repair and whilst this is an unusual tumor, the survival with aggressive surgical therapy may be better than that for small bowel adenocarcinomas that occur sporadically. Usually, these patients present with iron deficiency anemia, gastrointestinal bleeding, obstruction, or pain. Other malignancies such as eso-phageal cancer or melanoma are increased in frequency in celiac disease, though again the absolute risk is low. Some recent evidence suggests that risk of breast cancer may be reduced in patients with celiac disease, though this is yet to be confirmed.

Comparative Genomic Hybridization In Cancer Cytogenetics

Tumors, including prostate cancer, testicular germ cell tumors, breast cancer, uveal melanomas, small-cell lung carcinoma, gliomas, sarcomas, head, neck, and pancreatic carcinomas, and uterine leiomyomata. The chromosomal aberrations detected by CGH have also provided prognostic information in a number of neoplasms including renal cell carcinomas, bladder cancer, cervical carcinomas, node-negative breast cancer, uveal melanoma, cutaneous melanoma, and prostate cancer. Various international CGH databases have been established including Tokyo Medical and Dental University CGH database (http the database of Humboldt-University of Berlin (http ksch cghdatabase index.htm), the Progenetix cytogenetic online database (http, and the National Cancer Institute and National Center for Biotechnology Information Spectral Karyotyping SKY and Comparative Genomic Hybridization CGH Database (2001), (http sky). These databases provide a wealth of...

Benign Tumors Of The Skin

Of having a skin cancer, or, less frequently, because a concerned parent or spouse For most tumors, the initial diagnostic biopsy is also therapeutic. To ensure suitable specimens consisting of epidermal and dermal elements along with subcutaneous fat, we recommend excisional biopsies over shave biopsies because the latter are too superficial. This is particularly relevant in cases of pigmented lesions when melanoma is part of the differential diagnosis. However, if the lesion is larger than 2 cm or is located on the face, genitals, or digits, an incisional or punch biopsy is advisable to document the diagnosis prior to therapeutic excision.

Management of Melanocytic Nevi

Junctional, compound, and intradermal nevi have negligible malignant potential and surgical excision is indicated only for cosmetic or diagnostic reasons. Congenital melanocytic nevi larger than 10 cm must be excised because they have a 6 chance of malignant transformation. Dysplastic nevi must be excised to rule out melanoma. Nevus of Ota is best treated with lasers (11). Both the alexandrite (755 nm) and Q-switched ruby laser (694 nm) are effective but require multiple sessions given 8 weeks apart.

Antibody conjugates with CVF

Elicit complement-dependent target cell killing through the formation of membrane attack complexes. Antibody conjugates with CVF have been shown to kill human melanoma cells, human lymphocytes and leukemia cells, and human neuroblastoma cells. The concept of coupling CVF to monoclonal antibodies seems particularly promising in light of the fact that many monoclonal antibodies against tumors bind with good specificity but do not activate biological effector mechanisms such as complement. The coupling of CVF to monoclonal antibodies therefore introduces a biological effector function to the antibody.

TABLE 784 Neoplasms of the Anal Region

Included among the anal canal neoplasms is Kaposi's sarcoma, the most common AIDS-related malignancy. Ihe anal canal is the third most common site for malignant melanoma (after the skin and the eye), which, when it occurs there, may not be pigmented and is frequently overlooked.

Mechanisms Of Invasion And Metastases

These various processes are under the genetic control of 'metastasis-promoting' genes which may have dominant positive effects. Metastases-suppressor genes also have been identified, of which nm23 on chromosome 17q has received particular attention. This gene, which was first isolated from murine melanoma cell lines of high metastatic potential, is closely homologous to a fruit fly gene associated with normal wing development. Its expression in human tumours interacts with aggressiveness.

Management of Distant Metastatic Disease MM Stage IV

Mean survival for stage IV melanoma is 6 months. The majority of advanced melanoma cases either do not respond or have marginal responses to treatment. However, several clinical trials using chemotherapy and interleukin-2 (IL-2) have demonstrated lasting complete responses in a small number of patients. Some patients with metastases do relatively well, including some with solitary metastases to brain, lung, or skin. Dimethyl triazeno imidazole cartoxamide (DTIC) is the best single chemother-apeutic agent for stage IV melanoma, with a 20-30 response rate (163,164). Temo-zolamide is a new chemotherapeutic agent with activity similar to DTIC (165). It is less emetic, has better CNS penetration, and can be taken orally. Other agents, single and in combination, are not superior to DTIC. The initial 55 response rate reported for the so-called Dartmouth Regimen (Carmustin, DTIC, cisplatin, tamoxifen) has not been reproduced. Furthermore, tamoxifen itself has minimal activity against MM....

Aims for primary prevention

Primary prevention refers to the interventions designed to prevent skin cancer from occurring for the first time. Interventions for primary sun protection aim to change risk behaviour in order to reduce new skin cancers. Studies that evaluate such interventions usually use behaviour change as a surrogate for decrease in melanoma incidence, because of the difficulties in following up very large populations over decades in order to document such incident tumours. Proxy measures such as knowledge and attitudes may also be used. The main sun-protection strategies are the wearing of wide-brimmed hats, staying out of the sun between 11 am and 3 pm, and the use of shade. Sunscreens are a popular prevention strategy the evidence of their effectiveness in reducing the risk of skin cancers is considered in Chapter 23.

Effects of Solar UV Radiation on Aquatic Organisms

In humans, increased UV-B exposure may cause skin cancer, eye damage, and changes in the immune system (Griffiths et al. 1998). However, deleterious effects of UV-B radiation are also observed in aquatic organisms and ecosystems (H der et al. 1995). There are many studies concerning the effects of UV-B irradiation on phytoplanktonic organisms (Helbling et al. 1992). However, zooplankton and benthic invertebrates are also prone to UV-B damage (Hunter et al. 1979 Damkaer et al. 1980 Karanas et al. 1981 Malloy et al. 1997). In particular, sessile species such as sponges and corals are sensitive to the adverse effects caused by UV-B radiation (reviewed in Acevedo and Nolan 1993). These animals do not possess a UV-B-adsorbing epidermal layer like higher plants and animals and cannot avoid the harmful effects of solar radiation.

Comment on multifacet strategies to increase sunscreen use and sun protective behaviour

These multistrategic interventions are the most difficult to interpret collectively because of the plethora of outcome objectives. They remain difficult to design and require substantive formative research to appropriately determine specific behavioural outcome measures for each target group and for the selection of educational strategies for delivering the intervention. Those reporting indicate that interactive educational strategies are the most effective for increasing solar protection scores. Campaigns over time have the best outcome for increasing knowledge about skin cancer and use of sunscreens.

Oxidative Stress Related Disorders

Oxidative stress is implicated in the inflammatory demy-elination that characterizes multiple sclerosis suggesting GST polymorphisms may be associated with disability. In 177 patients with disease duration over 10 years, GSTM3 AA (OR 2.4) and homozygosity for both GSTM1*0 and GSTP1*Ile105-encoding allele (OR 5.0) were linked with severe disability suggesting that long-term prognosis in MS is influenced by GST-mediated ability to remove toxic products of oxidative stress. 1 Exposure to ultraviolet radiation also results in local oxidative stress in skin. Response to such exposure, examined as minimal erythema dose, has been shown to be mediated by GSTM1 and GSTT1 genotype in a gene dosage-dependent manner. 19 Furthermore, nonmela-noma skin cancer has also been linked to these poly-

Effects of Social Support Interventions on Health Status

Divided literature on this survival effect. Four other studies have shown an effect of psychotherapy on cancer survival time of cancer patients two involving lymphoma, one with melanoma, and one with gastrointestinal cancers. All of the psychosocial interventions were effective in reducing distress. Some involved supportive-expressive interventions, while others emphasized more cognitive-behavioral approaches and training in active coping. However, five others studies show no effect of psychotherapy on survival time. All but one involve breast cancer patients the other lung and gastrointestinal cancers. Only two of these five studies were able to demonstrate psychological effectiveness in reducing distress. One study conducted by Pamela Goodwin was a major multicenter trial using the supportive-expressive model. This program was quite effective in reducing distress, but there was no treatment effect on survival time. Clearly further evidence is needed to resolve the provocative...

Lymph node surgery in malignant disease

Tumour cells invade the venules and lymphatics in and around the primary cancer and also float down the draining veins and lymphatics. Most of these circulating cancer cells are destroyed, but some can develop into metastatic tumour in either lymph glands or distant organs. Metastatic spread is not in a centrifugal manner and local lymph nodes are often bypassed with metastatic deposits developing in more distal nodes. Tumour deposits in local lymph nodes are a clear indication of the metastatic potential of the primary tumour and in general are associated with an unfavourable outcome. A curative operation for a primary cancer aims to remove the primary tumour, surrounding tissue infiltrated by tumour and regional lymph nodes with metastatic deposits. Block dissection of uninvolved nodes do not improve outcome and are infrequently performed. In breast and melanoma surgery, new techniques are being developed to diagnose lymph node deposits in order to prevent unnecessary block...

The Hanganutziu Deicher HD system

And then by Deicher in 1926 in patients who received injections of sera of foreign species origin administered for serum therapy. Subsequently, H-D antibodies were found in human sera from many pathological conditions, though usually in low frequencies. H-D antigen is found in the tissues of all mammals studied to date, but it is absent from normal human tissues. On the other hand, it has been demonstrated in some human pathologic tissues, notably lymphoma and melanoma. Chemically, H-D antigen is an N-glycolylneuraminic acid, but many H-D-posi-tive human sera contain antibodies combining with other antigenic moieties found in the high molecular weight glycoprotein fraction of sheep and bovine erythrocytes. Serologically characteristic is the disappearance of agglutination of sheep erythrocytes after absorption of sera containing H-D antibodies with bovine red blood cells as well as with guinea pig kidney suspension.

Combined Locoregional And Systemic Chemotherapy

The inclusion criteria for the trial were unresectable liver metastases with hepatic involvement less than 50 no evidence of disease outside the liver (a complete staging, including an accurate intraoperative assessment, was mandatory, with biopsy of every suspected lesion) no concomitant serious disease (at the hepatic, renal, cardiac, or metabolic level) a good performance status (PS), 0-2 according to ECOG score a satisfactory bone marrow function no major contraindication to laparotomy, when required (during a long period of this trial the percutaneous catheter insertion was not yet available) no previous chemotherapy for advanced disease (adjuvant treatment was allowed if terminated at least 1 yr before the occurrence of metastases) no previous tumour (with the exception of basocel-lular skin cancer and early cervical carcinoma) oral informed consent, and, lastly, geographic accessibility (of particular importance for this complex treatment).

Background Definition

Squamous cell carcinoma (SCC) is a form of skin cancer that originates from epithelial keratinocytes.1 It is thought to arise as a focal intra-epidermal proliferation from precancerous lesions, including actinic keratoses, SCC in situ, Bowen's disease, bowenoid papulosis, erythroplasia of Queyrat and arsenical keratoses.2 Without treatment, SCC may continue to grow, invade the dermis or subcutaneous tissues or metastasise.3 This chapter focuses on interventions for localised, non-metastatic invasive SCC. The prevention of SCC is dealt with in Chapter 22.

Mohs micrographic surgery

MMS is a form of surgery that is performed in stages over several hours. The surgeon functions as a pathologist and extirpates the tumour and immediately evaluates the extirpated tissue, which is processed under frozen section. Before closure, the positive margins are removed in subsequent stages and final closure is performed once the tumour is declared fully removed by the attendant histopathologist. MMS is thought to be a highly curative procedure for non-melanoma skin cancers since immediate histopathological evaluation permits further tumour extirpation in successive stages. Although more tumour is removed from the positive margins in these stages, the remaining tissue is spared since only the tumour is removed, limiting potential damage to adjacent tissues.

Environmental Factors in the Etiology of Human Cancer Chemical Agents and Processes

As noted in Chapter 1, the incidence of cancer at various tissue sites in humans varies greatly among countries and even within certain countries. Immigrants and especially their descendants tend to acquire the cancer incidences characteristic of their new habitats. The conclusion has been drawn that a high percentage, perhaps as much as 80 , of the more frequent and statistically important human neoplasms (of the bronchi, stomach, colon, breast, and others) have environmental factors, including lifestyle, as major components of their etiology. This has further led to a general agreement that at least 50 of all human cancers could be avoided if existing etiological knowledge were applied (cf. Tomatis et al., 1997). Differences in the exposure to carcinogenic radiations other than solar ultraviolet (UV) light as the major cause of skin cancer , infectious disease, or hormonal factors do not appear sufficient to explain the geographical differences noted for most of the major cancers....


BCC (or rodent ulcer) is the most common malignant cutaneous neoplasm found in humans.1-3 For example, over 30 000 new cases are reported each year in the UK. This is likely to be an underestimate because of inconsistencies in registration of BCCs at regional cancer registries.4 Many registries only register a person's first skin cancer, thus further underestimating the real burden of the problem. in the Trent Cancer Registry (UK) increased from 36-8 in 1985 to 71-3 for men, and from 25-6 to 52-0 in women (Trent Cancer Registry, written communication, September 2001). A total of 3826 new BCCs were registered in Trent in 2000 (80 of all non-melanoma skin cancers). A sustained rise in the incidence of BCC has been documented using a validated register in South Wales, UK.6 Reliable national figures for BCC incidence are impossible to obtain because some cancer registries in the UK do not register BCCs. In the US, the incidence of BCC has doubled approximately every 14 years7 and similar...

Vaccination therapies

The majority of known TAA peptides are presented in association with Class I MHC molecules and are recognized by tumor-specific CD8+ T cells, whereas a small number of TAA is recognized by CD4+ T cells in the context of MHC Class II. Most of the known TAA peptides are expressed by melanoma, while a few TAA epitopes have been characterized in other tumors 8, 9 . Melanoma peptides were the first to be tested in patients with metastatic melanoma. In general, clinical responses were observed in 0-30 of the treated patients. Cormier et al. 10 vaccinated melanoma patients with Melan-A MART-1 with incomplete Freund's adjuvant and 15 out of 16 patients developed a specific CTL response in their blood, but no clinical responses were observed. In contrast, Rosenburg vaccinated patients with modified gp100 peptide and a high dose of IL-2 and demonstrated in 42 of the patients a clinical response 11 . Whether these responses could be attributed to the vaccination or the systemic treatment with...

In vitro biological activities

IL-8 has profound effects on nonleukocytic cells. IL-8 is haptotactic (induces cell migration to cell surface- or matrix-bound gradient), and promotes adhesion and proliferation of melanoma cclls. It inhibits collagen expression in synovial fibroblasts and enhances cytomegalovirus replication in lung fibroblasts. Furthermore, IL-8 induces the migration of human umbilical vein endothelial cclls in vitro and angiogenesis in rat cornea.

Cellular source of IL10

IL-10 is produced by several types of cells, including activated T lymphocytes, monocytes, B cells as well as nonhematopoietic sources such as keratinocytes, colon carcinoma and melanoma cells. In humans though Th2 T cell clones are the main source of IL-10, many T l clones will also secrete IL-10 following antigen-specific stimulation. In contrast, mlL-10 is produced by the T(I2 subset of CD4+ T cells but not by TM1 or CD8+ T cells. In humans both CD4+ and CD8+ T cells secrete IL-10 following stimulation with anti-CD3, although significantly higher levels are produced by CD4+ T cells. Among the CD4* T cells, CD45RO+ memory cells produce 10-fold higher level of IL-10 than naive T-cells (CD45RA+). Murine Ly-1 B cells as well as Epstein-Barr virus transformed human B cells produce IL-10. Human monocytes are also a major source of IL-10 in response to activation with lipopolysaccharide. Interestingly, kinetics studies reveal that IL-10 is synthesized later than other immunoregulatory...

Prognostic Set Of Genes In

Figure 2 shows the gene set that is considered the best for discriminating between patients with good clinical outcome and poor outcome based on subclusters generated by hierarchical clustering, instead of gene by gene. Some of the individual genes that were not selected may still have prognostic value. However, in our selected set of genes, many of them provide insights into the biology of the two groups of ccRCC. For example, sprouty, the mammalian homolog of the Drosophila melanogaster angiogenesis inhibitor, was up-regulated exclusively in the good outcome group, suggesting that failure to properly inhibit angiogenesis may contribute to the aggressive form of ccRCC. The regulator of G-protein signaling 5 was exclusively up-regulated in the good outcome tumors and may be important for the proper control of cancer progression. Transforming growth factor-p receptor II (TGFfiRII) and its downstream effector, tissue inhibitor of metalloproteinase 3 (TIMP-3), were exclusively...

Mortality and morbidity

About 106 000 people around the world were diagnosed with cutaneous melanoma in 1990. Since melanoma can be a fatal disease if diagnosed at a late stage, this represents many lost potential life-years, as well as direct costs to health services. It is estimated that at Figure 22.2 Estimated age-standardised rates for cutaneous melanoma of the skin in 1990 least 2 750 000 people were diagnosed with non-melanocytic cancers (basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)) of the skin in 1985. These represent more than 30 of newly diagnosed cancers.2 Mortality from melanoma increased after the 1970s, particularly in white males, possibly as a result of increased recreational exposure to sunlight.3,4 During the next few years about 51 400 individuals are expected to develop melanoma and almost 7800 to die of the disease. The incidence increased 126 between 1973 and 1995, at a rate of approximately 6 per year. Non-melanocytic skin cancers are not usually considered life...

Clinical Description And Prevalence

The incidence of melanoma is rising faster than all other cancers except lung cancer in women, currently varying between 5 (Western Europe) and 20 (Northern Europe) to over 50 (Queensland, Australia) cases per 100,000 per annum. 1,2 Familial clustering of melanoma was first described by Norris in 1820, 3 but it was not until the second half of the 20th century before others documented the familial occurrence of melanoma. Across several population-based studies, 1-13 of melanoma cases reported the occurrence of melanoma in at least one first-degree relative. 4 Hence, it is commonly accepted that melanoma predisposition is hereditary in 10 of all cases. But even in high-sun-exposure areas such as Queensland, Australia, less than 5 of melanoma probands report two or more first- or second-degree relatives affected with melanoma. 5 Whereas susceptibility in small numbers of highly selected multiple-case melanoma families is consistent with autosomal dominant inheritance of a single major...

Molecular Genetics

The first identified melanoma susceptibility gene, located on chromosome 9p21-p13, has been known by many different names MTS1, INK4A, CDKN2. The currently accepted gene nomenclature is CDKN2A, which stands for cyclin-dependent kinase inhibitor 2A. This locus was mapped by linkage analysis in families in which melanoma was considered the sole phenotype, rather than including a nevus phenotype as well. 13 By using different first exons, exon 1a and 1p, respectively, CDKN2A encodes for two proteins, p16INK4A (commonly referred to as p16) and p14ARF (alternative reading frame). Both proteins are tumor suppressors involved in cell cycle regulation. p16 inhibits phosphorylation (and thereby activation) of the retinoblastoma gene product (pRb) by CDK4 and CDK6. p14ARF inhibits HDM2 degradation of p53. Thus, loss of function of either protein drives cell cycle progression through deregulation of either the pRb or p53 pathways (Fig. 2). Most germline mutations in CDKN2A are missense mutations...

Genotypephenotype Correlations

The International Melanoma Genetics Consortium has estimated the penetrance of melanoma in CDKN2A mutation-positive family members between different geographical locations to range from 58 to 91 by the age of 80 years, with an average of 67 . 22 The broad confidence intervals make it impossible to provide precise melanoma risks. Mutations affecting only p16 compared to those affecting both p16 and p14ARF showed a trend (although not statistically significant) toward a higher penetrance in the latter. Mutations affecting only p14ARF have been described in two melanoma families and an individual with multiple melanomas. Additionally, another multiple melanoma case and two other families have deletions of part of chromosome 9p that encompass both p16 and p14ARF coding sequences. Each of the latter and one of the p14ARF-only mutated families have cases of nervous system tumors. 7 These observations suggest that whereas both p16 and p14ARF predispose to melanoma, it is mutation of p14ARF...

Molecular Genetic Testing Genetic Counseling And Clinical Management

Molecular genetic testing in familial melanoma is currently considered premature by the International Melanoma Genetics Consortium1-23-1 for the following reasons. First, the mutation detection rate in melanoma families is very low. Second, risk estimates for mutation carriers are not well established (and have broad confidence intervals). In particular, the risk for other cancers, such as pancreatic cancer, is not clearly defined. Third, surveillance programs for mutation carriers have not yet been proven to be effective, questioning the medical benefit of the DNA test result. The last and most critical reason for not currently offering genetic testing in familial melanoma is the increased risk for melanoma in nonmutation carriers in CDKN2A mutation-positive families. Predictive DNA testing then should only be offered within the bounds of a clearly defined research protocol. In this setting, extensive genetic counseling addressing the limited value of testing in familial melanoma is...

Dimensions of Costs

While a number of studies of psychotherapy for cancer patients illustrates its beneficial effects in improving adjustment and ameliorating emotional distress, three groups in particular document improved survival when psychotherapy is added to the treatment plan. These cancers are as follows breast cancer, malignant melanoma, and leukemia and lymphoma.

Approaches to immunotherapy with LAK or ANK cells

Performed to determine the toxicity and antitumor efficacy of this form of immunotherapy in patients with advanced malignancies. The results from these early trials, some performed with IL-2 alone and others with a combination of LAK cells and IL-2, have not been as encouraging as originally expected. More than 70 of patients with advanced malignancies treated with immunotherapy did not respond, and some patients demonstrated severe toxicities that were subsequently linked to the high doses of IL-2 administered. On the other hand, 25-30 of patients with metastatic melanoma and renal cell carcinoma unresponsive to conventional therapy responded to immunotherapy with LAK cells plus IL-2. As more experience with adoptive immunotherapy was acquired, it became clear that improvements in this form of therapy are necessary and may indeed result in better overall response rates. The advantages and disadvantages of continuous versus bolus administration of IL-2 have been debated. Lowering the...

Photoimmunology in humans

Although most of our information about photoimmunology comes from studies of laboratory animals, evidence of immunological effects of sunlight and UV exposure on humans is beginning to accumulate. Exposing human skin to sunlight or artificial sources of UV radiation causes the same types of alterations to human Langerhans cells as previously described in mice. Furthermore, human keratinocytes secrete a variety of immune modulatory factors following UV exposure, including IL-1, IL-6, Il.-lO, TNFa and PGE2. Sensitization of humans with contact allergens through the UV-irradiated skin also suppresses the contact hypersensitivity reaction. Interestingly, although the UV-induced suppression of contact hypersensitivity was evident in approximately 40-50 of irradiated normal human volunteers, almost 100 of skin cancer patients were susceptible to the suppressive effects of UV radiation. These findings not only suggest that there is a genetic component that influences the sensitivity of...

Sentinel lymph node biopsy

In recent years, sentinel lymph node (SLN) mapping and biopsy have been well established for intermediate to thick melanoma and clinically node-negative breast cancer. In a study of 114 patients (from Emory University School of Medicine) with thick melanoma (s4 mm), 32.5 had a positive SLN biopsy, half of which had a single-positive lymph node after dissection. The overall 3-year survival for SLN-negative patients was 82 versus 57 for node-positive patients.

Nucleotide Excision Repair Biology

Several human hereditary diseases have been identified that result from defective NER. The so-called classical xeroderma pigmentosum (XP) is an autosomal-recessive disease that results from defects in both global NER and TC-NER. Affected individuals are extremely sensitive to sunlight and have a markedly increased risk of developing skin cancers. A clinically indistinguishable form of XP called the XP variant form, derives from mutations that affect a different biological response to UV radiation-induced DNA damage. Individuals with mutations in genes required for both NER and RNA polymerase II transcription can develop the clinical features of both XP and a different disease called Cockayne syndrome (CS). Pure CS (unaccompanied by XP) arises from defects in the CSA or CSB genes that encode proteins required for TC-NER. Unlike XP, CS does not lead to an increased risk of skin cancer in human subjects. Defects in subunits of TFIIH can result in a spectrum of diseases characterized by...

Allium Organosulfur Compounds

Ratios of phase 1 and phase 2 drug-metabolizing enzymes. Various garlic preparations including aged garlic extract have been shown to inhibit the formation of nitrosamine-type carcinogens in the stomach, enhance the excretion of carcinogen metabolites, and inhibit the activation of polyarene carcinogens. Inhibitory effects of organosulfur compounds on the growth of cancer cells in vitro, including human breast cancer cells and melanoma cells, have been observed. Modulation of cancer cell surface antigens, associated with cancer cell invasiveness, has been observed, and in some cases cancer cell differentiation can be induced. AGE can reduce the appearance of mammary tumors in rats treated with the powerful carcinogen dimethyl benz(a)anthracene (DMBA), which is activated by oxidation by cytochromes P450 to form the DNA binding form of DMBA diol epoxide, resulting in DNA legions and cancer initiation. The antibacterial activity of these allium compounds may also prevent bacterial...

Box 411 Skin phototype

Skin phototype is a classification used to determine the risk of cutaneous sunburning and tanning tendency following exposure to ultraviolet radiation. It is useful in determining the dose regimens for phototherapy and photochemotherapy, an individual's susceptibility to photoageing and skin cancer, and the degree of photoprotection required. Phototypes are categorised in a range of I-VI.16

Might There Be Deleterious Consequences of Introducing DNA Hypomethylation in the Genome As a Cancer Therapy

The DNA methylation inhibitors 5-azacytidine, 5-aza-2'-deoxycytidine (decitabine), and 5,6-dihydro-5- azacytidine have been used as cancer chemotherapeutic agents in clinical trials on various neoplasms, including refractory acute leukemia 89 myelodysplastic syndrome 90 advanced non-small cell lung cancer 91 malignant mesothelioma 92 accelerated or blast phase of chronic myeloid leukemia 93 advanced ovarian or cervical carcinoma 94,95 malignant melanomas and colorectal, head and neck, and renal carcinomas.96 For solid tumors, usually little or no clinical efficacy and often no disease stabilization was seen, but many toxic effects were observed.89,91,94-9 Combination therapy on malignant mesothelioma, which showed a low response to 5,6- dihydro-5-azacytidine alon,92 did not improve the response rate (17 ) and increased the toxicity.97 There has been considerable attention recently to testing the efficacy of treatment of high-risk myelodysplastic syndrome (MDS) with 5-azacytidine or...

Tumor antigens recognized by T cells

The study of animal models has clearly demonstrated that the immune system has the capacity to reject tumor cells and that T lymphocytes are instrumental in this rejection. In particular, the essential role of cytotoxic T lymphocytes (CTLs) was highlighted by adoptive transfer studies and by the analysis of tumor variants escaping rejection, which were found to have lost CTL epitopes. A number of mouse tumors were found to express one or several antigens recognized by CTLs derived from lymphocytes of mice having rejected these tumors. In humans, antitumor CTLs were obtained in vitro from the lymphocytes of cancer patients, and a number of antimela-noma CTL clones have been analyzed in detail. The study of melanoma variants that were resistant to some but not all of these CTL clones revealed that melanoma cells express several distinct antigens. The molecular definition of these antigens has afforded crucial insights into both the specificity of these tumor antigens and the mechanism...

Uses of antibody imaging

Thus, the use of immunoscintigraphy for initial diagnosis of tumors is limited to specific regions, such as ocular melanoma, in which biopsies are not possible. Immunoscintigraphy can also be useful for staging of cancer. In particular, immunoscintigraphy may be superior to 67Ga scanning for the staging of malignant lymphoma. Useful application of immunoscintigraphy has been found in the detection and localization of recurrence in colon cancer, choriocarcinoma, germ-cell tumors, and thyroid carcinoma. Antibodies to CEA and CA19-9 are frequently reported to be used for radioimaging of metastatic and recurrent lesions. Hand-held y-probes in combination with radiolabeled antibodies have also

Dietary Vitamin D Intakes and Low Vitamin D Status in the US

The other major determinant is poor skin exposure to sunlight, mainly to UV-B that is responsible for the conversion of 7-dehydrocholesterol to 25(OH)D3 in the dermis layer of the skin. In the US, inadequate exposure has become a major contributor over the last few decades because of concerns about skin cancer and because of increased indoor activities, including television and computers. (This poor dietary consumption and poor skin production of vitamin D seems to be paralleling the increase in overweight.) Because it is even more difficult to assess skin exposure for vitamin D synthesis, it has been extremely difficult to estimate with accuracy the additional need for dietary vitamin D. Seasonal variations yield wide swings or oscillations in skin production, depending on the position of the sun. For example, in the northern hemisphere, the highest skin production rates occur in the late spring, summer, and early autumn months (May to October), whereas in the southern hemisphere,...

Immune responses to human neoplasms

Cell-mediated immune reactions are demonstrated in assays of either CTL activity or T helper cell responses, with most work nowadays concentrating on antigens recognized by CTLs. Since tumor cell killing by CTL is restricted by the ability of a given patient's MHC class I molecules to present target peptides, an antigen targeted by CTLs will appear as unique to each neoplasm, even if it is shared by many tumors, unless the tumor cells and the CTLs are matched for MHC class I. As a result of recent work taking this into account, as well as earlier studies studying the outcome of T helper cell activity, it has been established that the immune response to human neoplasms is primarily directed towards TADAs that are shared by many tumors. The MAGE group of tumor antigens discovered by Boon's group represents an interesting example. While MAGE antigens were first found in melanoma, they are shared by several other tumors as well. Their degree of tumor selectivity varies between different...

Sex Differences in Incidence

Figures A.13-A.18 show the male female ratios for the major adult cancers. The plots highlight two kinds of information. First, the values on the y axis measure the male female ratio, with positive values for male excess and negative values for female excess. The scaling is explained in the legend of Figure A.13. Second, the trend in each plot shows the relative acceleration of male and female incidence with age. For example, in Figure A.13, the positive trend for lung cancer shows that male incidence accelerates with age more rapidly than does female incidence, probably because males have smoked more than females, at least in the past. Positive trends also occur consistently for the colon, bladder, melanoma, leukemia, and thyroid. Negative trends may occur for the pancreas, esophagus, and liver, but the results for those tissues are mixed among locations. Simple nonlinear curves seem to explain the patterns for the stomach and Hodgkin's, and maybe also for oral-pharyngeal cancers....

Neurovascular Anatomy

Figure 20 Temporoparietal fascial flap inset over a facial defect, providing a vascularized surface for a split-thickness skin graft. The defect (A) resulted from a wide local excision of a skin cancer zygomatic bone was exposed. A temporoparietal fascial flap (B) was harvested and transferred over the defect. A skin graft was placed (C) and the final appearance is shown (D). Figure 20 Temporoparietal fascial flap inset over a facial defect, providing a vascularized surface for a split-thickness skin graft. The defect (A) resulted from a wide local excision of a skin cancer zygomatic bone was exposed. A temporoparietal fascial flap (B) was harvested and transferred over the defect. A skin graft was placed (C) and the final appearance is shown (D).

Malgnant Percardal Effuson Wth Tamponade

Malignant melanoma Hodgkin's lymphoma Lung carcinoma Breast carcinoma Ovarian carcinoma Malignant melanoma has special predilection for the heart, but the most common cause of malignant pericardial effusion is carcinoma of the lung and breast. Pericardial disease also can result from mediastinal irradiation, infection, or drugs such as cyclophosphamide, granulocyte-macrophage colony-stimulating factor (GM-CSF), and cytarabine.

Management of Primary SCC

Treatment of SCC varies depending on its cause, anatomical site, growth rate, previous treatment, size, depth of invasion, differentiation, patient's immune status, and perineural invasion. It is important to encourage microstaging as in melanoma using depth and Clark's level.

Pharmacodynamic PD properties

Anthracycline Semiquinone

In general, the antitumor activity of doxorubicin and epirubicin appears to be similar in various orthotopic tumor models as well as in human tumor xenografts in nude mice. Differences in the spectra of antitumor activity have been noted but it appears that the predictive value for clinical use remains uncertain. Both drugs, DOX and EPI, showed activity against breast carcinoma, small cell lung cancer, and sarcoma and were not active in colon tumors 13 . In non-small cell lung cancer the in vivo results showed activity in three quarters of tumors transplanted into nude mice with both anthracyclines, a result which does not correlate with clinical results. The same holds true for melanoma. For this reason in vivo evaluations in a large panel of human tumors in nude mice can only give a first indication for future clinical development. There is clearly a limitation of tumor in vivo models which do not reflect correctly the tumor biology in humans, e.g., host-tumor interactions in man...

Laparoscopy For Ascites And Peritoneal Malignancyresults

The use of laparoscopy must be considered paramount for the complete assessment of patients who present with intra-abdominal malignancy with or without ascites. Most intra-abdominal cancers may be associated with ascitic collections and small implants on the peritoneal surface. In addition, extra-abdominal malignancies such as breast and melanoma may have significant intra-abdominal presentations with both ascites and peritoneal implants.

Therapeutic modification of the immune response

A considerable literature now exists on the use of genetically engineered cytokines in the treatment of cancer. Initial enthusiasm has now abated with the realization that the immune system can not easily be turned on to tumor targets by the indiscriminate activation of the immune system by cytokines such as IL-2 and interferon a. However, interferons do have a defined role and proven efficacy in the management of certain conditions, particularly melanoma, renal cell carcinoma and hairy cell leukemia and as adjuvant therapy in certain hematological malignancies such as low-grade lymphoma and myeloma. Interleukin 2 was first used in studies at the National Cancer Institute in the mid-1980s and attracted widespread attention as a potential breakthrough in the treatment of renal cell carcinoma and melanoma. Studies elsewhere have confirmed an effect in these tumors but only in a small number of patients and at high cost in toxicity. The in vitro expansion of cells from tumor samples,...

Mouse Skin Multistage Carcinogenesis Model That Unmasks Epigenetic Lesions Responsible For Metastasis

Abstract Although there is a wide range of accepted models of tumorigenesis involving genetic lesions, the timing and hierarchy of epigenetic alterations associated with tumor progression and metastasis are still poorly understood. In this regard, the best characterized mouse carcinogenesis system, the multistage skin cancer progression model, has recently been used to identify epigenetic alterations during tumor progression and to provide decisive information about how epigenetic lesions precede metastasis. This model reveals a progressive global loss of genomic methylcytosine that is associated with the degree of tumor aggressiveness and that occurs in the context of increasing numbers of hypermethylated CpG islands of tumor-suppressor genes during the most malignant stages of carcinogenesis. DNA microarrays coupled with demethylating drug treatments confirm the progressive establishment of hypermethylation events from the early stages to the most aggressive phenotypes. It is of...

Clinical Features

A pyogenic granuloma initially presents as a bright red, shiny papule with a thin collarette of hyperkeratosis. It may be ulcerated and tends to bleed profusely with minor injury. Later, the lesion reepithelializes and becomes a dull red to purple color. Although these lesions can occur anywhere on the body, the extremities, especially the hands, are the most common sites of involvement. The differential diagnosis includes amelanotic melanoma, squamous cell carcinoma, bacillary angiomatosis, and cutaneous metastasis.

Muscle antigens Smooth muscle

Sera from patients with chronic active hepatitis contain antibodies to smooth muscle antigens that are detectable by IIF and bind smooth muscle of all organs. The major antigen of the smooth muscle is actin. The antibodies belong mainly to the IgG class, but they can also be found in the IgM class. The test is performed on unfixed cryostat sections of rodent stomach as substrate. Smooth muscle antibodies arc found in 40-70 of patients with active chronic hepatitis, with lower titers found in 50 of patients with primary biliary cirrhosis, and 28 of patients with cryptogenic cirrhosis. These antibodies are also found at low titer in patients with acute viral hepatitis, infectious mononucleosis, asthma, yellow fever and malignant tumors (carcinomas of the ovary, malignant melanoma). They have been found in less than 2 of the normal population.

Genetic Testing And Counseling In Hereditary Breast And Ovarian Cancer Syndrome

Breast, ovarian, colon, and prostate cancer Breast, ovarian, prostate, pancreatic, bile duct and gall bladder, stomach cancer, and malignant melanoma Soft-tissue sarcomas, breast cancer, brain tumors, acute leukemia, and other epithelial and mesenchymal tumors Breast cancer, thyroid cancer, and colonic neoplasms

Role of Fas FasL in immune privilege and immune escape

A similar mechanism of elimination of activated T cells by constitutive expression of FasL may provide a means of escape from the immune system by tumor cells. Certain tumors, including a proportion of melanomas, colon cancer cells and hepatocellular carcinomas, have been demonstrated to constitutively express FasL and appear to use this as a means of evading the T cell immune response by eliminating tumor-reactive T cells as they become activated. Enari M, Sakahira H, Yokoyama H et al (1998) A caspase-activated DNase that degrades DNA during apoptosis, and its inhibitor ICAD. Nature 39154-50. Fisher GH, Rosenberg FJ, Straus SE et al (1995) Dominant interfering Fas gene mutations impair apoptosis in a human autoimmune lymphoproliferative syndrome. Cell 81 935-946. Green DR and Ware CF (1997) Fas-ligand privilege and peril. Proceedings of the National Academy of Sciences of the USA 94 5986-5990. Hahne M, Rimoldi D, Schroter M et al (1996) Melanoma expression of Fas (Apo-l CD95) ligand...

Effects on Particular Organs or Organ Systems

Ultraviolet light from the sun is a form of ionizing radiation that can cause skin cancer, or melanoma. The basal cells and melanocytes are vulnerable to UV. It is feared that the destruction of stratospheric ozone by substances such as chlorofluorocarbons will result in increased UV radiation at the ground level, leading to increased melanoma. Such an increase has already been observed in Australia, which has also experienced declines in stratospheric ozone.

Alternative explanations for the phenomena assigned to the immune surveillance theory

Tumor incidence in immunodeficiency are also entirely plausible. The increased tumor incidence in immunodeficient renal transplant patients is primarily due to an increase in skin cancer (squamous cell carcinoma) and non-Hodgkin lymphoma (the majority being of B cell origin), whereas a substantial increase in the more common cancer types, such as breast cancer, cancer involving the respiratory system, and gastrointestinal cancer, is not observed in these patients. Non-Hodgkin lymphoma and skin cancer in immunodeficiency are associated with a viral etiology (Epstein-Barr virus (EBV) and human papillomavirus (HPV), respectively). It is therefore conceivable either that these viruses are carcinogenic themselves or that the increased frequency of viral infection acts as a cofactor, making the infected cell vulnerable to becoming a tumor cell. With regard to immunosuppression, it should be noted that only parts of the immune system are immunosuppressed (generally the T cell compartment)....

Recombinant vaccines expressing tumor associated antigens

These promising results were the reason to perform a large Phase III study with stage II and stage III colon cancer patients under the auspices of the Eastern Cooperative Oncology Group (ECOG) 32 . This study differed from the Hoover study in that, due to large number and wide geographic distribution of sites involved, each site performed its own vaccine manufacturing. It is possible that because of the fact that these centers were not making vaccines on a daily basis, the quality of vaccines was not always according to the required standards. In an intent-to-treat analysis of all randomized patients, there were no significant differences between the two treatment arms in time to recurrence or overall survival. In the ECOG study, 12 of all vaccines failed to meet quality control specifications (cell number viability), and 15 of the vaccinated patients failed to have adequate DTH reactions. It was hypothesized that the poor quality of a part of the vaccinations could have caused the...

Adrenal Incidentaloma

Patients should also be questioned in depth about a history of prior malignancy, change in bowel habits, blood in the stool or urine, previous mole removal, and tobacco use. Positive answers to these questions might suggest that the mass may be secondary to a metastases, especially from a breast, lung, colon, melanoma, or renal

Cbt For Emotional Distress

In general, with regard to enhancing cancer patients' emotional well-being, the trend has been to evaluate the efficacy of multicomponent protocols that include a variety of CBT strategies. For example, Telch and Telch (1986) found a group-administered multicomponent CBT coping skills training protocol, composed of relaxation and stress management, assertive communication, cognitive restructuring and problem solving, management of emotions, and planning pleasant activities, to be superior to a supportive group therapy condition. A landmark multicomponent CBT-based investigation was conducted by Fawzy and his colleagues (Fawzy et al., 1990) and included patients who were newly diagnosed with malignant melanoma. The 6-week CBT intervention was comprised of four components health education, stress management, problem-solving training, and group support. At the end of the 6 weeks, patients receiving the structured intervention began showing reductions in psychological distress as compared...

Sage Uses In Human Genome Mining And Annotation

Recently, SAGE analysis of primary glioblastoma cells led to the identification of the homolog of the melanoma-associated antigen gene family (MAGE-E1) as over-expressed in glioblastoma cells. MAGE-E1 expression was only detected in brain and ovary, among normal tissues. Although the function of this gene is unknown, it holds potential to serve as a glioma marker (23).

Effectiveness Azathioprine

All of the immunosuppressants currently available carry potentially serious side-effects such as kidney damage (ciclosporin), bone marrow suppression (azathioprine), osteoporosis (systemic steroids) and skin cancer (photochemotherapy). These are described in more detail in the systematic review. It is difficult to make any statements about how useful these drugs are in comparison with one another because the impact of these adverse effects (for example azathioprine-induced bone marrow

Thymic peptides as immunoregulators or biological response modifiers

TPs have been used clinically as antiviral agents and in the immunotherapy of cancer. TP5 is a highly effective drug as an antiviral therapy in recurrent herpes simplex, herpes zoster and human papilloma virus infection, reducing the relapse rate. It has also been shown to be a safe and effective adjunct to therapy in patients with severe atopic dermatitis, in which it decreases the release of polymorphonuclear leukocyte-derived inflammatory mediators. TP5 is able to produce consistent clinical and immunological effects in melanoma patients with cutaneous metastases, and is a potentially useful agent in the treatment of a subgroup of patients with Sezarv syndrome. Combination therapies with Tal are used in infections and tumors, for example, AZT, Ta 1 and IFNa in HIV patients. Tal is being used in clinical trials of head and neck cancer, advanced non-small-cell lung cancer and metastatic melanoma. Tal is being used in hepatitis B and C trials worldwide. Other thymic preparations such...

Malignant Liver Tumours 14621

MRI is extremely efficient at differentiating between metastasis and benign lesions such as hae-mangiomas or cysts (Mitchell, Saini, Weinreb et al. 1994). Most liver metastatic deposits will appear hypointense on T1 weighted images and hyperin-tense on T2. Although the signal intensity on T2 weighted images is usually less than typically seen in haemangiomas and benign cystic lesions there may be confusion particularly where metastatic deposits have areas of central necrosis or cyst formation (Bartolozzi et al. 1999). Some endocrine tumour deposits may also demonstrate extremely high signal on T2 weighted images (these include carcinoid, islet cell tumour, renal carcinoma, thyroid carcinoma and phaeochromocytoma) (Morana et al. 2002). Meta-static disease from malignant melanoma will show different signal characteristics due to the presence of paramagnetic melanin within the tumour cells. This produces deposits which may be hyperintense on T1 weighted images and hypointense on T2....

Vitamin E

Cancer is caused by mutations in key genes. Anything that protects DNA will, in theory, help to prevent cancer-causing mutations. Lipid peroxide degradation products are reported to be carcinogenic, and vitamin E opposes lipid peroxidation, possibly conferring indirect protection against cancer. Furthermore, by interacting with reactive species elsewhere in the cell, vitamin E may spare other antioxidants, thereby also indirectly protecting DNA. Vitamin E reportedly protects against cancer of the upper digestive tract, skin cancer, including melanoma, and lung cancer. Follow-up analysis of the placebo group of the Finnish ATBC (Alpha Tocopherol Beta Carotene) study (incidentally, a study that showed no protection against lung cancer


A number of trials have attempted to investigate the effect of -carotene supplementation on nonme-lanoma skin cancer, the most common forms of which are basal cell and squamous cell carcinomas (these types of cells are both found in the top layer of the skin). However, none have shown any significant effect on skin cancer prevention. For example, the Physicians Health Study found no effect after 12 years of -carotene supplementation on the development of a first nonmelanoma skin cancer. The Nambour Skin Cancer Prevention Trial of 1621


The Nutritional Prevention of Cancer Trial in the United States also supported a possible protective role of selenium (Table 4) 1312 patients (mostly men) with a previous history of skin cancer were supplemented with either placebo or 200 mg selenium per day for 4 years and those receiving selenium demonstrated significant reductions in the risk of cancer incidence (37 ) and mortality (50 ). Although selenium was not found to have a protective effect against recurrent skin cancer, the selenium-treated group had substantial reductions in the incidence of lung, colorectal, and prostate cancers of 46, 58, and 63 , respectively. Further analysis showed the protective effect on prostate cancer to be confined to those with lower baseline prostate-specific antigen and plasma selenium levels. Although these data need confirmation, they suggest that adequate selenium intake may be important for cancer prevention.

Cost analysis

Cost analysis is the most fundamental pharmacoeconomic study. This type of analysis deals solely in costs and does not directly account for the outcome of the therapy. Researchers can report their results from either micro-costing or macro-costing. Micro-costing involves enumerating each component of a therapeutic strategy and then determining the cost of each component. Tsao et a .1 used micro-costing methods to determine the annual direct cost of diagnosing and treating melanoma. The authors systematically itemised the components of direct healthcare costs for melanoma care such as excisional biopsies, excision with primary closure, encounters with physicians, lymph node biopsy and interferon alpha. They estimated the annual direct cost of treating newly diagnosed melanoma in 1997 to be US 563 million.

Costutility analysis

Freedberg et al.6 published a CUA comparing a one-time screening strategy for melanoma with a no-screening strategy. They primarily used life-year saved as their outcome measure, but they also used an estimate of utilities to estimate a QALY outcome. They found the CE ratio for the screening programme to be US 29 170 per life-year saved and US 30 360 per QALY. While the strategy of screening once in a lifetime may not mimic reality, the analysis was a good beginning for investigating the cost-effectiveness of melanoma screening. Before interpreting the QALY result (US 30 360 per QALY), readers should realise that the criterion for cost-effectiveness, called the CE threshold, is arbitrary and open to debate. A cost-effective therapy is one that delivers more QALYs per dollar (or costs fewer dollars per QALY) compared with some benchmark. Researchers consider therapies less than US 50 000 per QALY to be relatively cost-effective whereas those greater than US 175 000 per QALY are not.7-9


Tumorigenesis due to deficiencies of various minerals has been reported, among them selenium (50), iron (51), zinc (52), and molybdenum (53). Data regarding others are sparse but available (5). Antitumor effects of selenium in experimental carcinogenesis have also been reported (54,55). A recently reported clinical trial designed to test the efficacy of dietary selenium treatment for prevention of skin cancer found no effect with regard to the stated objective (56). However, selenium treatment proved efficacious against other forms of cancer. A total of 1312 patients with basal or squamous cell carcinomas were treated with a selenium-containing preparation. Cancer incidence in the selenium-treated group was 77 cases compared with 119 cases in the controls, a highly significant difference. All-cause mortality was lower in the selenium-treated individuals (108 vs 129 in controls). Total cancer deaths numbered 29 in the treated group compared with 57 in the placebo group. Over the total...

DNA Repair

Some humans have an inherited autosomal recessive condition called xeroderma pigmentosum. These persons are exceedingly sensitive to getting skin cancer from exposure to sunlight. The condition can be diagnosed in infancy, enabling people to lead fairly normal lives by protecting themselves from exposure to the sun. The condition seems to be related to a number of different mutations, including about seven that affect excision repair, and to reduced activity of the enzyme that uses blue light to repair thymidine dimers.

Prevention Issues

All of the above interventions are geared to impact on health and mental health parameters after a person is diagnosed with cancer. However, treatment strategies can also affect behavioral risk factors, thus attempting to prevent cancer to some extent. Some of the most important cancer-related behavioral risk factors include smoking, alcohol, diet, and sun exposure. Reviews of the relevant CBT treatment literature bases concerning the first three areas are included in other sections of this encyclopedia and therefore will not be repeated here. With regard to sun exposure, some interventions have led to increased knowledge of skin cancer and awareness of protective measures however, programs have had only limited success with increasing preventive behaviors in at-risk groups.

Phase 2 Studies

Peters laid out the rationale for using HDC ABMT to treat breast cancer patients in 1985 in a study of various solid tumors, including breast cancer (Peters 1985). In May 1986, Peters, Antman, and Frei reported the results of a phase 1 study of highdose combination alkylating agents with ABMT, involving 29 patients, of whom 9 were patients with metastatic breast cancer the others had metastatic colon cancer, melanoma, lung cancer, various sarcomas, and testicular cancer (Peters et al. 1986). The purpose of the study was to determine the maximum tolerable dose of HDC Doses 3 to 15 times standard doses were administered before dose-limiting toxicity was encountered. This study progressed to a phase 2 trial in breast cancer within a few months (Eder et al. 1986). Seventeen patients with metastatic breast cancer, 13 of whom had received prior chemotherapy, were treated with HDC ABMT among the 16 patients who could be evaluated were 14 responders, including 6 complete responses. Tumor...


Many pioneers of radiation research, including Madame Curie, died from cancer. In the 1930s a high incidence of osteosarcomas was reported in luminous watch-dial painters who ingested radium from licking brushes. During the following decade a high incidence of leukaemia and skin cancer was observed amongst radiologists. A variety of cancers follow radiotherapy for benign conditions, most notably those of breast, thyroid and liver and following irradiation for ankylosing spondylitis. Other physical forms of tissue damage may lead to the development of cancer. Burns or gravitational ulcers predispose to skin cancer, and asbestos, silicates and synthetics to lung and pleural cancers.

Umumuh U M U

Searching for new methylated genes by combining cDNA microarray technology with 5-aza-2-deoxycytidine treatment. A. Measurement of 5-methylcytosine content by HPCE in mouse skin cancer cell lines treated and untreated with 5-aza-2-deoxycytidine. Results are expressed as the mean SD. B. representative blocks of a MouseChip array showing overexpression (red circles) of igfbp3 gene in CarC cell line relative to MCA3D. C. Summary of the methylation-specific PCR (MSP) and bisulfite sequencing analyses of the CpG island methylation status of five positive genes in the DNA microarray. D. Schematic representation of the methylation status of the CpG islands of some of the candidate genes in several mouse skin cancer cell lines obtained by bisulfite genomic sequencing. E. Example of the MSP analysis of some of the candidate genes identified. F. Example of the RT-PCR analysis of the Ache, and prdx1 genes. Restoration of gene expression is observed in PAM212 cell lines treated with Aza...

Other measures

Studies of the incidence and locality of a cancer in a country can be correlated with environmental factors, for example diet (fat and colon cancer), occupation (asbestos workers and mesothelioma) or climate (melanoma and exposure to the sun). However, such correlations tend to be crude as they can only consider factors which affect the whole population and not its individual members.

Photodynamic therapy

Photodynamic therapy (PDT) utilizes a combination of light and photosensitizing drugs to treat accessible deposits of cancer. First used in Germany in 1903 with a combination of eosin and light to treat skin cancer, in its modern form it uses low-energy lasers and a synthetic photosensitizer, derived from the blood of cows and pigs (Photfrui). The drug is injected intravenously when it is concentrated in all cells. However, unlike normal cells which only retain the drug for several hours, tumour cells retain it for several days. If they are exposed to low energy they are destroyed. Initially used to treat metastatic tumour deposits on the skin, extending the laser source using fibreoptic cables allows light to be applied to oesophageal, bronchial and gastrointestinal cancers. The mechanism of action is not fully understood, but apparently a toxic form of oxygen is released and this damages cell membranes and other cellular components, particularly in the blood vessels feeding tumour...

Pericardial effusion

Metastatic disease involving the heart is discovered in up to 20 per cent of autopsied cancer patients, but clinically significant cardiac involvement is much less common. Pericardial involvement is most frequently encountered in patients with cancers of the lung, breast, gastrointestinal tract, melanoma, lymphoma, and leukemia. Malignancy is the most common cause of cardiac tamponade (16-41 per cent),39 but radiation, drugs, infection, hypothyroid-

Risk factors

Epidemiological evidence suggests that skin cancers, non-melanocytic skin cancers (NMSCs) and melanoma are caused in the main by exposure to UV radiation (UVR) and repeated episodes of sunburn (erythema) in childhood and adulthood. Genetic susceptibility or phenotype, including the number of naevi on the skin, may have a role in the development of skin cancers for some populations and individuals. Exposure to UVR and susceptibility (phenotype) are risk factors associated with the incidence of sunburn, solar keratoses and precancerous lesions. The type of exposure - intermittent (i.e. lying for long periods in the sun on annual foreign holidays) or continuous (i.e. daily exposure over long periods, as in those working outdoors) - may differ between the three main types of cancer.7 It is thought that risk increases with increasing intermittency of exposure. Evidence supports this increased risk for melanoma, probably for BCC, but not for SCC. The risk for SCC appears to depend only on...