• Etiology and prevention of melanoma.

• Commentary: self interest is not the sole legitimate basis for making decisions.

• Interferon alfa-2a for melanoma metastases.

• Interferon as adjuvant treatment for melanoma.

• Response rates of patients with metastatic melanoma to high-dose intravenous interleukin-2 after prior exposure to alpha-interferon or

• Stay out of the sun.

• In vivo evaluation of 188Re-labeled alpha-melanocyte stimulating hormone peptide analogs for melanoma therapy.

• Role of lymphoscintigraphy and intraoperative gamma probe guided sentinel node biopsy in head and neck melanomas.

• Sentinel lymphadenectomy in cutaneous melanoma.

• The role of sentinel lymph node biopsy in patients with stage I/II cutaneous melanoma. The clinical experience at the National Cancer

• Activating transcription factor 2-derived peptides alter resistance of human tumor cell lines to ultraviolet irradiation and chemical

• [Experiences with therapy of stage IV metastatic malignant melanoma with "Legha Protocol" polychemoimmunotherapy]

• Should the skin cancer examination be taught in medical school?

• Pegylated interferon alfa-2b treatment for patients with solid tumors: a phase I/II study.

• Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma.

• [Nevi, sun and the risk of melanoma]

• Cancer immunotherapy. Select T cells, given space, shrink tumors.

• Malignant melanoma: non-metastatic.

• Diagnosis and management of nevi and cutaneous melanoma in infants and children.

• Why ultraviolet protection with clothing makes sense.

• Determination of potential adjuvant systemic therapy benefits for patients with resected cutaneous melanomas.

• [Use of local magnitothermia in the treatment of patients with primary-confined skin melanoma]

• Prolonged survival of patients receiving active immunotherapy with Canvaxin therapeutic polyvalent vaccine after complete resection of

• MDs and ozone depletion: be careful not to turn patients into "cancerphobes".

• Protection against ultraviolet radiation.

• Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs

• Vaccinating patients with autologous tumor.

• Vaccination of metastatic melanoma patients with autologous tumor-derived heat shock protein gp96-peptide complexes: clinical and

• Adjuvant immunotherapy of patients with high-risk melanoma using vaccinia viral lysates of melanoma: results of a randomized trial.

• Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study.

• Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate.

• [Mucous malignant melanoma of the neck and face. Experience at the Salah Azaiz Institute (Tunis)]

1
UI - 11962258
AU - Mackie BS; Mackie LE
TI - Etiology and prevention of melanoma.
SO - Nutr Cancer 2001;40(2):211-3

2
UI - 9549462
AU - Weijer C
TI - Commentary: self interest is not the sole legitimate basis for making decisions.
SO - BMJ 1998 Mar 14;316(7134):850
AD - Mount Sinai Hospital, Toronto, Ontario, Canada.

3
UI - 11918944
AU - Kirkwood JM; Ibrahim JG; Sondak VK; Ernstoff MS; Ross M
TI - Interferon alfa-2a for melanoma metastases.
SO - Lancet 2002 Mar 16;359(9310):978-9

4
UI - 12243953
AU - Wheatley K; Ives N; Hancock B; Gore M
TI - Interferon as adjuvant treatment for melanoma.
SO - Lancet 2002 Sep 14;360(9336):878

5
UI - 12074048
AU - Weinreich DM; Rosenberg SA
TI - Response rates of patients with metastatic melanoma to high-dose intravenous interleukin-2 after prior exposure to alpha-interferon or low-dose interleukin-2.
SO - J Immunother 2002 Mar-Apr;25(2):185-7
AD - Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
We evaluated 567 patients with metastatic melanoma who were treated with high-dose intravenous interleukin-2 (IL-2) to determine whether prior treatment with either alpha-interferon or low-dose IL-2 altered the rates of response to subsequent high-dose IL-2. Of the 567 patients treated, 46 patients had received low-dose IL-2 before, and 78 had received alpha-interferon before. The response rate for patients who had received IL-2 before compared with IL-2 naive patients was 15% versus 21% respectively (p = 0.39). The response rate for patients who had received alpha-interferon before compared with patients who had not was 13% versus 21% (p = 0.084). Therefore, prior low-dose IL-2 therapy does not appear to prevent a subsequent response to high-dose IL-2. There is a trend for patients who received alpha-interferon before to have a lower-response rate to subsequent high-dose IL-2, but the number of patients evaluated in this study is too small to definitively answer this question.

6
UI - 12219447
AU - Palmer R
TI - Stay out of the sun.
SO - Nurs Stand 2002 Aug 7-13;16(47):27
AD - Sloane Hospital, Beckenham, Kent.

7
UI - 12216078
AU - Miao Y; Owen NK; Whitener D; Gallazzi F; Hoffman TJ; Quinn TP
TI - In vivo evaluation of 188Re-labeled alpha-melanocyte stimulating hormone peptide analogs for melanoma therapy.
SO - Int J Cancer 2002 Oct 10;101(5):480-7
AD - Department of Biochemistry, University of Missouri-Columbia, Columbia, MO 65211, USA.
The purpose of our study was to optimize melanoma tumor uptake of 188Re-CCMSH and reduce its nonspecific kidney retention. Nephrotoxicity is often a serious problem associated with targeted radiotherapy, therefore, increasing the tumor/kidney uptake ratio of 188Re-CCMSH is crucial for optimizing its therapeutic efficacy. Structural modification of the peptide and amino acid co-infusion were investigated as strategies to improve the tumor/kidney uptake ratio of 188Re-CCMSH. The substitution of Lys11 with Arg11 was examined to determine if removal of lysine from the peptide would improve kidney clearance without sacrificing tumor uptake. The pharmacokinetics of 188Re-CCMSH and 188Re-(Arg(11))CCMSH were determined in B16/F1 murine melanoma-bearing C57 mice. Tumor uptake values of (188)Re-CCMSH and 188Re-(Arg(11))CCMSH were 15.03 +/- 5.20% ID/g and 20.44 +/- 1.91% ID/g at 1 hr postinjection and 1.94 +/- 0.47% ID/g and 3.50 +/- 2.32% ID/g at 24 hr postinjection. Renal retention of 188Re-(Arg(11))CCMSH was 11.79 +/- 1.29 ID/g and 3.67 +/- 0.51 ID/g at 1 hr and 4 hr postinjection, which was a greater than 50% reduction compared to 188Re-CCMSH. The Arg for Lys substitution in 188Re-(Arg(11))CCMSH resulted in improved tumor uptake and reduced kidney retention. Renal retention of both 188Re-CCMSH and 188Re-(Arg(11))CCMSH were significantly reduced by co-injection of 20 mg of L-lysine, L-arginine and a combination of L-lysine:L-arginine. Tumor/kidney uptake values for 188Re-CCMSH and 188Re-(Arg(11))CCMSH were maximally reduced by 52.9% and 46.3%, respectively. However, even with amino acid co-injection, the tumor/kidney ratio of 188Re-CCMSH was lower than that of 188Re-(Arg(11))CCMSH. Improved tumor uptake and reduced kidney retention of 188Re-(Arg(11))CCMSH will facilitate targeted irradiation of melanoma tumors while minimizing the dose to the kidneys. Copyright 2002 Wiley-Liss, Inc.

8
UI - 12365375
AU - Maccauro M; Gallino F; Aliberti G; Savelli G; Castellani MR; Villano C;
TI - Baio SM; Goilo AE; Belli F; Mansi L; Bombardieri E Role of lymphoscintigraphy and intraoperative gamma probe guided sentinel node biopsy in head and neck melanomas.
SO - Tumori 2002 May-Jun;88(3):S22-4
AD - UO Medicina Nucleare, Istituto Nazionale Tumori, Milan. maccauro@istitutotumori.mi.it

9
UI - 12369552
AU - Buonomo O; Felici A; Granai AV; Piccirillo R; De Liguori Carino N;
TI - Guadagni F; Mariotti S; Orlandi A; Tipaldi G; Cipriani C; Chimenti S; Cervelli V; Casciani CU; Roselli M Sentinel lymphadenectomy in cutaneous melanoma.
SO - Tumori 2002 May-Jun;88(3):S49-51
AD - Department of Surgery, University of Rome Tor Vergata, Italy. o.buonomo@inwind.it
AIMS AND BACKGROUND: In the last ten years validation of the sentinel lymph node (SLN) concept has led to modification of the surgical approach for patients with intermediate-risk cutaneous melanoma. METHODS AND STUDY DESIGN: Forty-eight patients affected by cutaneous melanoma with a Breslow thickness between 0.65 and 4 mm were enrolled in the study. Approximately 2 mCi of radiotracer and 1 mL of vital blue dye were injected in each patient around the site of the primary lesion. Lymphoscintigraphy was performed until the lymphatic basin and the respective SLN were localized. The whole surgical procedure consisted of enlargement of the surgical margins followed by localization and excision of the SLN(s) by using both radiotracer and vital dye. Whenever the SLN proved to be histologically positive for metastasis, complete regional lymphadenectomy was performed. RESULTS: Within 15 minutes of radiotracer administration the lymphatic basin was localized in all 4 patients by lymphoscintigraphy. Vital dye and radiotracer successfully allowed SLN localization and excision in 46 of 48 patients (97%); in one case the SLN was detected by radiotracer alone. The SLN proved to be metastatic in six (13%) of 46 evaluable patients; interestingly, in three of them the presence of metastatic cells was revealed only by immunohistochemistry. All patients with tumor-positive SLNs had primary lesions with a Breslow thickness = 2 mm. CONCLUSIONS: Sentinel lymphadenectomy is able to identify lymph node involvement in patients with cutaneous melanoma with a Breslow thickness > 1 mm, thus avoiding the risks associated with radical regional lymphadenectomy. Lymphoscintigraphy proved to be an important tool to obtain correct preoperative localization of the drainage basin, especially for melanomas located on the face and trunk.

10
UI - 12369556
AU - Cafiero F; Gipponi M; Di Somma C; Solari N; Peressini A; Gliori S;
TI - Bassetti C; Spina B; Nicolo G; Schenone F; Castagnola F; Queirolo P; Sertoli MR The role of sentinel lymph node biopsy in patients with stage I/II cutaneous melanoma. The clinical experience at the National Cancer Research Institute of Genoa, Italy.
SO - Tumori 2002 May-Jun;88(3):S55-6
AD - SC Oncologia Chirurgica Ospedale Voltri ASL3, Genoa, Italy. cafiero@hp380.ist.unige.it

11
UI - 11234888
AU - Bhoumik A; Ivanov V; Ronai Z
TI - Activating transcription factor 2-derived peptides alter resistance of human tumor cell lines to ultraviolet irradiation and chemical treatment.
SO - Clin Cancer Res 2001 Feb;7(2):331-42
AD - Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, New York 10029, USA.
Activating transcription factor 2 (ATF2) and its kinase, p38, play an important role in the resistance of melanoma to radiation and chemotherapy. Whereas ATF2 up-regulates the expression of tumor necrosis factor alpha, which serves as a survival factor in late-stage melanoma cells, p38 attenuates Fas expression via inhibition of nuclear factor-kappaB. We investigated whether ATF2-derived peptides could be used to alter the sensitivity of human melanoma cells to radiation and chemical treatment. Of four 50-amino acid peptides tested, the peptide spanning amino acids 50-100 elicited the most efficient increase in the sensitivity of human melanoma cells to UV radiation or treatment by mitomycin C, Adriamycin, and verapamil, or UCN-01, as revealed by apoptosis assays. Sensitization by ATF2 peptide was also observed in the MCF7 human breast cancer cells but not in early-stage melanoma or melanocytes, or in in vitro-transformed 293T cells. When combined with an inhibitor of p38 catalytic activity, cells expressing amino acids 50-100 of ATF2 exhibited an increase in the degree of programmed cell death, indicating that combined targeting of ATF2 and p38 kinases is sufficient to induce apoptosis in late-stage melanoma cells. The ability of the peptide to increase apoptosis coincided with increased cell surface expression of Fas, which is the primary death-signaling cascade in these late-stage melanoma cells. Overall, our studies identified a critical domain of ATF2 that may be used to sensitize tumor cells to radiation and chemical treatment-induced apoptosis and that can induce apoptosis when combined with inhibition of ATF2 kinase, p38.

12
UI - 12132295
AU - Fischer B; Knop J; Enk AH
TI - [Experiences with therapy of stage IV metastatic malignant melanoma with "Legha Protocol" polychemoimmunotherapy]
SO - Hautarzt 2002 Jun;53(6):393-9
AD - Klinik und Poliklinik fur Dermatologie, Venerologie und Allergologie, Universitatsklinikum Mainz.
BACKGROUND AND OBJECTIVE: Metastatic malignant melanoma (stage IV) is one of the most aggressive tumors. At the moment there is no safe therapy. Therefore the report of Legha et al., who achieved a rate of almost 10% of long-lasting complete remissions with a polychemoimmunotherapy using interleukin-2 and interferon-alpha in combination with cisplatin, vinblastine and dacarbazine, is a promising one. Because of these promising trends, we decided to treat our own patients with this therapy to examine the results, the side effects and the practicability on normal dermatological wards. PATIENTS/METHODS: From 1997 to 2000 we treated 28 patients with metastatic malignant melanoma with the polychemoimmunotherapy according to Legha's protocol. RESULTS: We achieved three complete (11.1%) and seven partial (25.9%) remissions (altogether 37%). Two of these patients are living relapse-free at the moment (7.4%). Three patients (11.1%) showed a stabilization of their disease, five patients (18.5%) had a mixed response and nine patients (33.3%) suffered progressive disease. CONCLUSIONS: The rate of complete and partial remissions was lower than those reported by Legha et al., however the rate of long-lasting complete remissions was almost identical. The follow-up time is still ongoing, so we have to limit our results to this period. We want to emphasize the practicability of this kind of therapy on normal dermatological wards in spite of the relatively high toxicity.

13
UI - 12224981
AU - Geller AC; Venna S; Prout M; Miller DR; Demierre MF; Koh HK; Gilchrest
TI - BA Should the skin cancer examination be taught in medical school?
SO - Arch Dermatol 2002 Sep;138(9):1201-3
AD - Department of Dermatology, Boston University School of Medicine, 720 Harrison Ave, DOB801A, Boston, MA 02118, USA. ageller@bu.edu
BACKGROUND: The fact that thin melanomas are associated with a greater than 95% survival rate, while later, more deeply invasive melanomas have a 5-year survival rate of less than 10%, demonstrates the potential personal and public health impact of early detection. The majority of patients with skin lesions are seen by nondermatologists who infrequently counsel patients about skin cancer prevention or perform a complete skin examination as part of routine care. We documented the antecedents of physician practice by evaluating medical students' observation, training, performance, and self-reported skill level for the skin cancer examination and sun protection counseling. METHODS: Surveys were administered and completed in classrooms and student workshops in each of the 4 medical school years during the spring of 1996 and 1997. We concentrate our analysis on the graduating fourth-year students. RESULTS: Of the 302 fourth-year students enrolled at Boston University School of Medicine, Boston, Mass, in 1996 and 1997, 223 (74%) completed surveys. Among fourth-year students, 52% rated themselves as unskilled in skin cancer examinations. Twenty-eight percent of fourth-year students had never observed a skin cancer examination, 40% had received no training, and 35% had never practiced the examination. However, fourth-year students reporting at least 1 opportunity to observe, train, or practice an examination were 3 times as likely to report themselves as moderately to very skilled as students without such opportunities. CONCLUSION: If medical student training rates for the skin cancer examination are equally low elsewhere, as is likely, the present data suggest that even brief additions to the current curriculum, integrated into systems teaching, would augment student exposure and likely boost student skill levels.

14
UI - 12228203
AU - Bukowski R; Ernstoff MS; Gore ME; Nemunaitis JJ; Amato R; Gupta SK;
TI - Tendler CL Pegylated interferon alfa-2b treatment for patients with solid tumors: a phase I/II study.
SO - J Clin Oncol 2002 Sep 15;20(18):3841-9
AD - Experimental Therapeutics Program, Cleveland Clinic Cancer Center, Cleveland, OH 44195, USA. bukowsr@cc.ccf.org
PURPOSE: The efficacy of interferon alfa has been established in treating advanced melanoma and renal cell carcinoma (RCC) patients. We conducted a phase I/II study to determine the maximum-tolerated dose (MTD), the safety and tolerability, and the preliminary efficacy of once-weekly pegylated interferon alfa-2b (IFNalpha-2b) in patients with advanced solid tumors (primarily RCC). PATIENTS AND METHODS: To determine the MTD, 35 patients with a variety of advanced solid tumors received 0.75 to 7.5 micro g/kg/wk of pegylated IFNalpha-2b by subcutaneous injection for 12 weeks. An additional 35 previously untreated RCC patients received 6.0 and 7.5 micro g/kg/wk for up to 12 weeks. Patients with a response or stable disease after 12 weeks were eligible for the extension protocol and were treated for up to 1 year or until disease progression. RESULTS: The MTD for pegylated IFNalpha-2b at 12 weeks was 6.0 micro g/kg/wk. One year of 6.0 micro g/kg/wk was well tolerated with appropriate dose modification; no grade 3 or 4 fatigue occurred, and safety was comparable with that with nonpegylated IFNalpha-2b. The most common nonhematologic adverse events included mild to moderate nausea, anorexia, and fatigue. Six patients had grade 3 or 4 hematologic toxicity. Twenty-nine patients continued on the extension protocol. Four patients had a complete response, and five patients had a partial response. Among 44 previously untreated RCC patients, the objective response rate was 14%. Median survival for all RCC patients was 13.2 months. CONCLUSION: Pegylated IFNalpha-2b was active and well tolerated in patients with metastatic solid tumors, including RCC, at doses up to 6.0 micro g/kg/wk.

15
UI - 12229941
AU - Lawton G; Rasque H; Ariyan S
TI - Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma.
SO - J Am Coll Surg 2002 Sep;195(3):339-51
AD - Melanoma Unit of the Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06510, USA.
BACKGROUND: In patients with melanoma, there is considerable concern about the clearance of clinically negative nodes, partly because of the unacceptable morbidity reported after regional lymphadenectomy. The advent of sentinel lymph node biopsies has allowed us to select those patients with positive sentinel lymph nodes for completion node dissections. The purpose of this article is to demonstrate that when complete lymph node dissection is indicated, it can be performed with a low risk of lymphedema using the fascia-preserving technique. STUDY DESIGN: The records of 209 consecutive patients with melanoma who underwent fascia-preserving axillary (n = 116) or ilioinguinofemoral (n 1998 were reviewed. In each operation, care was taken not to disrupt the muscle fascia at the site of lymphadenectomy. RESULTS: In the fascia-preserving axillary group, there were 59 men and 47 women with mean age of 53 years (range 21 to 79 years). There were three recurrences (3%) outside the borders of dissection. Transient upper extremity edema (8%) resolved over a median of 5 months, and permanent upper extremity edema occurred in 5% of patients. In the ilioinguinofemoral group, there were 19 men and 37 women with a mean age of 52 years (range 21 to 88 years). There was one recurrence (2%) outside the borders of dissection. Transient lower extremity edema (48%) resolved over a median of 12 months, and permanent lower extremity edema occurred in 14% of patients. CONCLUSIONS: Preservation of the muscle fascia during lymph node dissection results in a lower incidence of permanent edema, with no increased risk of recurrence.

16
UI - 12233040
AU - Snellman E; Koulu L; Rantanen T
TI - [Nevi, sun and the risk of melanoma]
SO - Duodecim 2002;118(4):359-66; quiz 366, 401
AD - Paijat-Hameen keskussairaala, ihotautien tulosalue Keskussairaalankatu 7 15850 Lahti. erna.snellman@phks.fi

17
UI - 12242411
AU - Couzin J
TI - Cancer immunotherapy. Select T cells, given space, shrink tumors.
SO - Science 2002 Sep 20;297(5589):1973

18
UI - 12230768
AU - Crosby D; Crosby T; Mason M
TI - Malignant melanoma: non-metastatic.
SO - Clin Evid 2002 Jun;(7):1519-29
AD - Cardiff Community Healthcare Trust, Cardiff, UK.

19
UI - 11849894
AU - Fishman C; Mihm MC Jr; Sober AJ
TI - Diagnosis and management of nevi and cutaneous melanoma in infants and children.
SO - Clin Dermatol 2002 Jan-Feb;20(1):44-50
AD - Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. dgreco@partners.org

20
UI - 11899132
AU - Kaskel P
TI - Why ultraviolet protection with clothing makes sense.
SO - Br J Dermatol 2001 Dec;145(6):1030

21
UI - 12233924
AU - Thome SD; Loprinzi CL; Heldebrant MP
TI - Determination of potential adjuvant systemic therapy benefits for patients with resected cutaneous melanomas.
SO - Mayo Clin Proc 2002 Sep;77(9):913-7
AD - Division of Medical Oncology, Mayo Clinic, Rochester, Minn 55905, USA.
OBJECTIVE: To facilitate both better physician understanding of prognostic information (baseline and with adjuvant interferon) for individual patients who present with resectable melanomas and more informed patient decisions about whether they should receive adjuvant high-dose interferon therapy after resection of primary melanomas. PATIENTS AND METHODS: Baseline survival estimates were derived from a surgical database composed of 17,600 patients with complete clinical, pathologic, and follow-up data. Potential survival benefits ascribed to adjuvant interferon were obtained from results of a meta-analysis of Eastern Cooperative Oncology Group studies, which provided evidence for a uniform relative benefit of high-dose interferon across different baseline risk groups. A mathematical formula was then applied to these data to allow for individual prognostic information. RESULTS: The 5-year survival benefits in patients who received high-dose interferon after surgery, using the assumptions of the provided prognoses and interferon survival improvements, ranged up to 13%. CONCLUSIONS: These data should allow for a better understanding of baseline prognosis in individual patients and a better understanding of the potential benefits of adjuvant interferon. They should also help patients make more informed decisions regarding their treatment options.

22
UI - 11944360
AU - Korovin SI; Tolstopiatov BA; Medinets IuR; Protsenko VV; Dedkov AG;
TI - Palivets AIu; Smakova MS [Use of local magnitothermia in the treatment of patients with primary-confined skin melanoma]
SO - Lik Sprava 2002;(1):129-33
We studied modifying potentialities of high temperatures in treatment regimens with adjuvant endolymphatic chemo- and interferontherapy of malignant melanoma of the skin. We had previously obtained enough evidence for expediency of adjuvant endolymphatic therapy of primary-localized melanoblastoma of the skin. Added to the preventive treatment regimens were sessions of local magnetothermia. The study was done in patients diagnosed as having primary-localized melanoma of the skin T(2-4) No Mo. A 3-year recurrence-free survival in the control group was (38.2 +/- 1.6)%, in the first study group--(54.2 +/- 5.8)%, in the second study group--(44.3 +/- 13.5)%. The general 3-year survival in the control group was (67.7 +/- 1.5)%, in the first study group--(70.8 +/- 5.5)%, in the second one--(91.7 +/- 5.7)%. In this way, the expediency has been proved of employment of local magnetothermia in treatment regimens to deal with malignant melanoma of the skin.

23
UI - 12368672
AU - Morton DL; Hsueh EC; Essner R; Foshag LJ; O'Day SJ; Bilchik A; Gupta RK;
TI - Hoon DS; Ravindranath M; Nizze JA; Gammon G; Wanek LA; Wang HJ; Elashoff RM Prolonged survival of patients receiving active immunotherapy with Canvaxin therapeutic polyvalent vaccine after complete resection of melanoma metastatic to regional lymph nodes.
SO - Ann Surg 2002 Oct;236(4):438-48; discussion 448-9
AD - John Wayne Center Intitute, Santa Monica, Ca 90404, USA. mortond@jwci.org
OBJECTIVE: To determine whether adjuvant postoperative active specific immunotherapy with a therapeutic polyvalent vaccine (PV) called Canvaxin can prolong survival following complete resection of melanoma metastatic to regional nodes (American Joint Committee on Cancer [AJCC] stage III melanoma). SUMMARY BACKGROUND DATA: Despite complete lymphadenectomy, 5-year overall survival (OS) for patients with melanoma metastatic to regional lymph nodes is only 20% to 50%, depending on the number of tumor-involved nodes. In 1984, the authors began phase II trials of Canvaxin PV as postsurgical adjuvant therapy for AJCC stage III melanoma. METHODS: Patients who received PV between 1984 and 1998 were compared with patients who did not receive PV postsurgical therapy between 1971 and 1998. The seven covariates recently defined by the AJCC Melanoma Staging Committee (number of metastatic nodes, palpable status, ulceration, age, primary site, pT stage, and gender) were included by Cox regression in a multivariate model of OS. A computerized program matched PV and non-PV patients by these covariates. RESULTS: Of 2,602 patients who underwent complete lymphadenectomy for AJCC stage III melanoma with regional nodal metastases and were followed up by the same team of oncologists between 1971 and 1998, 935 received PV and 1,667 did not. Median OS and 5-year OS were significantly higher in PV than non-PV patients (56.4 vs. 31.9 months and 49% vs. 37%, respectively; P =.0001). When the non-PV patients were matched by the four most significant covariates, 447 matched pairs were formed between patients seen before or after January 1, 1985, and the OS was not different between the two time periods ( P=.789). However, when the PV patients were matched with non-PV patients by six covariates forming 739 pairs, the PV patients survived longer ( P=.0001). Detailed analysis of the 1,505 patients who were seen or who began vaccine therapy within 4 months after lymphadenectomy, and who had more complete data on the seven prognostic covariates showed that median OS and 5-year OS were higher in 445 PV patients than in 1,060 non-PV patients: 70.4 versus 31 months and 52% versus 37%, respectively (P =.0001). Multivariate Cox regression analysis identified six significant prognostic factors: number of metastatic nodes, size of metastatic nodes, pT stage, ulceration, age, and PV therapy. PV therapy reduced the relative risk of death to 0.64 (95% confidence interval, 0.55-0.76) ( P=.0001); sex and site of primary were of borderline significance. CONCLUSIONS: This large single-institution study independently confirmed the significance of prognostic covariates in the new AJCC staging system. By using modern statistical methods that controlled for all known prognostic factors, it also demonstrated PV's ability to significantly enhance OS. A multicenter phase III randomized trial is underway to validate the efficacy of PV as a postsurgical adjuvant.

24
UI - 1555168
AU - Morgan PP
TI - MDs and ozone depletion: be careful not to turn patients into "cancerphobes".
SO - CMAJ 1992 Apr 15;146(8):1397-9

25
UI - 1298228
AU - Hoffer A
TI - Protection against ultraviolet radiation.
SO - CMAJ 1992 Sep 15;147(6):839-40

26
UI - 12361412
AU - Lens MB; Dawes M; Goodacre T; Bishop JA
TI - Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs wide excision.
SO - Arch Surg 2002 Oct;137(10):1101-5
AD - Centre for Evidence-Based Medicine, University of Oxford, Nuffield Department of Clinical Medicine, The Oxford Radcliffe NHS Trust, Oxford, England.
BACKGROUND: The optimal excision margin for primary cutaneous melanoma remains controversial, although several clinical studies have suggested that wide local excision is unnecessary. HYPOTHESIS: Wide excision margins do not improve survival in patients with melanoma. OBJECTIVES: To describe the published evidence and determine the effectiveness of wide surgical margins compared with narrow surgical margins. DESIGN: Systematic review of randomized controlled trials that compared narrow margins with wide excision margins for cutaneous melanoma. SETTING: included trials comprised 2406 participants. INTERVENTION: Surgical excision of melanoma using narrow excision margins compared with excision using wide excision margins. MAIN OUTCOME MEASURE: Effect of width of excision margin on melanoma recurrences, disease-free survival, and overall survival. RESULTS: We identified and analyzed 4 randomized controlled trials. All 4 trials failed to demonstrate statistically significant differences in overall survival and disease-free survival when comparing wide vs narrow excision. Peto pooled odds ratio for overall survival was 0.79 (95% confidence interval, 0.61-1.04) and for disease-free survival was 0.89 (95% confidence interval, 0.69-1.13), indicating a statistically nonsignificant improvement with wide excision. CONCLUSIONS: Not one of the included studies showed any statistically significant difference between the 2 groups treated with narrow or wide excision margins with regard to recurrences and survival. However, current evidence is not sufficient to address the optimal surgical margins for all melanomas, and further research is required.

27
UI - 12377956
AU - Chapman PB
TI - Vaccinating patients with autologous tumor.
SO - J Clin Oncol 2002 Oct 15;20(20):4139-40

28
UI - 12377960
AU - Belli F; Testori A; Rivoltini L; Maio M; Andreola G; Sertoli MR; Gallino
TI - G; Piris A; Cattelan A; Lazzari I; Carrabba M; Scita G; Santantonio C; Pilla L; Tragni G; Lombardo C; Arienti F; Marchiano A; Queirolo P; Bertolini F; Cova A; Lamaj E; Ascani L; Camerini R; Corsi M; Cascinelli N; Lewis JJ; Srivastava P; Parmiani G Vaccination of metastatic melanoma patients with autologous tumor-derived heat shock protein gp96-peptide complexes: clinical and immunologic findings.
SO - J Clin Oncol 2002 Oct 15;20(20):4169-80
AD - Unit of General Surgery 2, Istituto Nazionale Tumori, Milan, Italy.
PURPOSE: To determine the immunogenicity and antitumor activity of a vaccine consisting of autologous, tumor-derived heat shock protein gp96-peptide complexes (HSPPC-96, Oncophage; Antigenics, Inc, Woburn, MA) in metastatic (American Joint Committee on Cancer stage IV) melanoma patients. PATIENTS AND METHODS: Sixty-four patients had surgical resection of metastatic tissue required for vaccine production, 42 patients were able to receive the vaccine, and 39 were assessable after one cycle of vaccination (four weekly injections). In 21 patients, a second cycle (four biweekly injections) was given because no progression occurred. Antigen-specific antimelanoma T-cell response was assessed by enzyme-linked immunospot (ELISPOT) assay on peripheral blood mononuclear cells (PBMCs) obtained before and after vaccination. Immunohistochemical analyses of tumor tissues were also performed. RESULTS: No treatment-related toxicity was observed. Of 28 patients with measurable disease, two had a complete response (CR) and three had stable disease (SD) at the end of follow-up. Duration of CR was 559+ and 703+ days, whereas SD lasted for 153, 191, and 272 days, respectively. ELISPOT assay with PBMCs of 23 subjects showed a significantly increased number of postvaccination melanoma-specific T-cell spots in 11 patients, with clinical responders displaying a high frequency of increased T-cell activity. Immunohistochemical staining of melanoma tissues from which vaccine was produced revealed high expression of both HLA class I and melanoma antigens in seven of eight clinical responders (two with CR, three with SD, and the three with long-term disease-free survival) and in four of 12 nonresponders. CONCLUSION: Vaccination of metastatic melanoma patients with autologous HSPPC-96 is feasible and devoid of significant toxicity. This vaccine induced clinical and tumor-specific T-cell responses in a significant minority of patients.

29
UI - 12377961
AU - Hersey P; Coates AS; McCarthy WH; Thompson JF; Sillar RW; McLeod R; Gill
TI - PG; Coventry BJ; McMullen A; Dillon H; Simes RJ Adjuvant immunotherapy of patients with high-risk melanoma using vaccinia viral lysates of melanoma: results of a randomized trial.
SO - J Clin Oncol 2002 Oct 15;20(20):4181-90
AD - Sydney Melanoma Unit, University of Sydney and Royal Prince Alfred Hospital, and the Cancer Council Australia, Sydney. peter.hershey@newastle.edu.au
PURPOSE: Patients with high-risk melanoma treated by immunotherapy with vaccinia viral lysates were found in phase II studies to have improved survival compared with historical controls. We therefore elected to test this therapy in a phase III study. PATIENTS AND METHODS: A prospective, randomized, multicenter trial to determine whether immunotherapy with a vaccine prepared from vaccinia melanoma cell lysates (VMCL) over a 2-year period after definitive surgery would improve relapse-free survival (RFS) and overall survival (OS) in patients with American Joint Committee on Cancer stage IIB and III melanoma compared with a control group treated only with surgery. RESULTS: A total of 700 patients were randomized: 353 to VMCL and 347 to no immunotherapy. Seventy-seven percent had lymph node (LN) metastases and 66% had clinically detected LN metastases. Analysis on the basis of all eligible, randomized patients (n = 675) found, after a median follow-up period of 8 years, a median OS of 88 months in the control versus 151 months in the treated group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.64 to 1.02; P =.068 by stratified univariate Cox analysis). At 5 and 10 years, survival rates for control and treated patients were 54.8% v 60.6% and 41% v 53.4%, respectively. Median RFS was 43 months in the control group compared with 83 months in the treated group (HR, 0.86; 95% CI, 0.7 to 1.07; P =.17). RFS at 5 years was 50.9% for the treated group and 46.8% for the control group. There were no selective benefits from the vaccine for particular subsets of patients. CONCLUSION: Immunotherapy with VMCL was not associated with a statistically significant improvement in OS or RFS, with CIs not ruling out important gains from such treatment.

30
UI - 12096293
AU - Fu MR; Anderson CM; McDaniel R; Armer J
TI - Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study.
SO - Oncol Nurs Forum 2002 Jul;29(6):961-6
AD - Sinclair School of Nursing, University of Missouri-Columbia, MO, USA. mf339@mizzou.edu
PURPOSE/OBJECTIVES: To explore patients' perceptions of fatigue in response to biochemotherapy treatment for metastatic melanoma. DESIGN: A descriptive-correlational, cross-sectional study. SETTING: A cancer center in the midwestern United States. SAMPLE: 12 adult patients between the ages of 28-70 who received at least one cycle of biochemotherapy treatment for metastatic melanoma (stages III and IV) from the inpatient or outpatient services of a midwestern cancer center. METHODS: A demographic data sheet and the Revised Piper Fatigue Scale (PFS) were used to collect data at a single point in time after patients received at least one cycle of biochemotherapy. FINDINGS: The majority of patients who received biochemotherapy reported severe or moderate fatigue. Female patients' total fatigue scores were higher than those of male patients. Fatigue duration varied from hours to months, with a maximum duration of 12 months after biochemotherapy treatment. All of the patients reported that the most direct causes of their fatigue were metastatic melanoma and biochemotherapy treatment. CONCLUSIONS: Patients who received biochemotherapy treatment for metastatic melanoma reported moderate to severe fatigue. Female patients experienced more intense fatigue than male patients. The findings also supported the multidimensionality of fatigue construct identified in prior fatigue studies. The four dimensions/subscales of fatigue assessed by the Revised PFS were highly correlated to total fatigue scores. IMPLICATIONS FOR NURSING: Biochemotherapy is a newer treatment modality for metastatic melanoma. Fatigue, one of the severe toxicities from biochemotherapy treatment, necessitates attention from nurses. The findings will assist nurses in teaching patients about fatigue that may be expected during or after biochemotherapy and about self-care strategies to manage fatigue.

31
UI - 12183762
AU - Schwartz AL; Thompson JA; Masood N
TI - Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate.
SO - Oncol Nurs Forum 2002 Aug;29(7):E85-90
AD - Department of Primary Care, School of Nursing, Oregon Health and Science University, Portland, OR, USA. schwarta@ohsu.edu
PURPOSE/OBJECTIVES: To examine the effect of exercise and methylphenidate on fatigue, functional ability, and cognitive function in patients with melanoma. DESIGN: Pilot study with comparison to historic controls. SETTING: University-based cancer center. SAMPLE: 12 patients with melanoma entered and completed the study. The mean age was 44 years. METHOD: Eligible patients were recruited before their first dose of interferon-a (IFN-a). Patients were instructed to take 20 mg sustained-release methylphenidate every morning and follow an aerobic exercise program four days a week for 15-30 minutes. Measures included a 12-minute walk, the Schwartz Cancer Fatigue Scale, Trail Maker Forms A and B, Medical Outcomes Study 36 Short Form, body weight, and daily logs. Fatigue scores were compared to usual care historical controls with melanoma receiving only IFN-a. MAIN RESEARCH VARIABLES: Fatigue, functional ability, and cognitive function. FINDINGS: 66% adhered to exercise and methylphenidate; all adhered to exercise. Fatigue was lower for the exercise and methylphenidate group than historic controls. Functional ability increased 6% for all patients and 9% for the exercise and methylphenidate group. Cognitive function was stable for the exercise and methylphenidate group. The exercise-only group showed marked cognitive slowing. CONCLUSION: The combination of aerobic exercise and methylphenidate may have a positive effect on fatigue, cognitive function, and functional ability. A larger sample size and randomized trial is needed to more rigorously evaluate the results of exercise and methylphenidate alone or in combination. IMPLICATIONS FOR NURSING: Although further study is needed, a combination of exercise and methylphenidate may be a practical intervention for patients receiving IFN-a for melanoma.

32
UI - 11938523
AU - Oueslati Z; Touati S; Gritli S; el-May A; Benna F; Boussen H; el-Khedim
TI - A; Ferjaoui M; Ladgham A [Mucous malignant melanoma of the neck and face. Experience at the Salah Azaiz Institute (Tunis)]
SO - Rev Laryngol Otol Rhinol (Bord) 2001;122(4):237-40
AD - Institut Salah Azaiz, Service de Chirurgie Carcinologique Maxillo-Faciale et Oto-Rhino-Laryngologique, Tunis, Tunisie.
The mucosal melanoma of the head and neck is rare and of late diagnosis. This retrospective study concerns 17 cases brought together in 30 years. Sex-ratio was of 1.1, the average age of 58 years. Tumoral seats were the following ones: nasal cavity and paranasal sinus (n = 10), nasopharyngeal cavity (n = 2), gingival seat (n = 2), palate (n = 1), laryngeal seat (n = 1), middle ear (n = 1). Tumoral extension was classified an follows: stage I: 52.9%, stage II: 17.6%, stage III: 29.4%. Melanomas were achromic in 23.5% of cases. On the therapeutic plan, 47.1% of the patients were treated in a purpose palliative because of the importance of the tumoral extension. Seven patients (41.2%) were treated surgically; three among them received an additional radiotherapy for an insufficient tumoral excision or adenopathy in break capsular. Two patients (11.8%) were treated by exclusive radiotherapy. The rates of survival were 17.6% in 2 years, and 5.9% in 5 years. The average duration of survival was of 18.1 months. The causes of failure were essentially local and metastatic.

The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.

About OncoLink  Contact OncoLink  Privacy statement   Disclaimer  Link to OncoLink  Home
For assistance please visit our HELP section
© Trustees of the University of Pennsylvania