Skin Cancer & Melanoma

BETHESDA, Md--Increased numbers of small nevi, large nondysplastic nevi, and clinically dysplastic nevi strongly increase a person's risk of developing melanoma--a finding with major preventive implications, according to investigators in a large, case-control study.

ASCO--Injections of an irradiated autologous melanoma vaccine genetically engineered to secrete GM-CSF proved safe and capable of eliciting an antitumor response in patients with advanced tumor burden, Robert Soiffer, MD, of the Dana-Farber Cancer Institute and Massachusetts General Hospital, said at an ASCO scientific session.

NEW YORK--Cancer Care, Inc. has introduced Crossing Bridges, a national program to provide medically accurate information and ongoing emotional support to malignant melanoma patients receiving adjuvant therapy with interferon alfa-2b (Intron A).

CHICAGO--Although interferon-alfa 2b (Intron A) has been used for some time to treat malignant melanoma patients at high risk for relapse after surgery, little has been known about the way in which it works.

HOUSTON--Just in time for another of Texas' legendary red-hot summers, The University of Texas M.D. Anderson Cancer Center is receiving national and local acclaim for a skin cancer prevention program aimed at fourth- and fifth-grade students.

NEW YORK--The Cancer Research Institute and Cancer Care, Inc. have announced The Melanoma Initiative, a program to support public awareness of melanoma, resources for melanoma patients, and clinical research. The Initiative is funded by an unrestricted educational grant from Schering-Plough Corporation.

FORT LAUDERDALE, Fla--Once primary melanoma is excised, choosing among adjuvant treatment options is a difficult decision, Daniel G. Coit, MD, of Memorial Sloan-Kettering Cancer Center, said at the National Comprehensive Cancer Network (NCCN) annual meeting. Dr. Coit presented the network's preliminary guidelines for melanoma, along with John A. Thompson, MD, of the University of Washington, Seattle.

A human cancer vaccine has, for the first time, been observed to promote the invasion of cancerous tissues by specific families of white blood cells that are believed to have a cancer-fighting effect.

A new gene, designated KiSS-1, has been isolated from cells of malignant melanoma, in which metastatic potential was suppressed by the introduction of normal human chromosome 6. According to the research report in the December 4th

A national study underway at Virginia Commonwealth University (VCU) will determine whether breast cancer patients can benefit from a biopsy procedure that has been successfully used for skin cancer patients. Patients with melanoma, the most serious kind of skin cancer, have benefited from an advance that has reduced the pain and complications of surgery performed to ascertain whether their cancer has spread.

PHILADELPHIA--Lymphocytes are known to infiltrate melanoma lesions at the primary site, occasionally resulting in spontaneous regressions. Therefore, investigators in search of specific treatments for metastatic melanoma have turned to immunologic approaches, John Kirkwood, MD, said at the 12th Annual Toward 2000 Symposium at Fox Chase Cancer Center.

Treatment with Mohs micrographic surgery produces cure rates of 93% to 99% for the most common skin cancers, basal cell carcinomas and squamous cell carcinomas, Perry Robins, md, reported in The 1996 Skin Cancer Foundation Journal.

A controversial treatment for melanoma, elective lymph node dissection (ELND), has again been shown to provide important prognostic information, according to a study presented at the 65th Annual Meeting of the American Society of Plastic and Reconstructive Surgeons (ASPRS) held in Dallas, Texas. Although the retrospective study did not demonstrate that ELND makes a difference in patient survival, it indicated that the information gained from the removal and testing of the lymph nodes could be crucial in predicting the patient's prognosis.

The role of elective lymph node dissection in the treatment of patients with early-stage melanoma remains controversial. Some surgeons advocate the routine use of elective node dissection in patients with intermediate-thickness primary tumors, but the cost, morbidity, and low yield of tumor-positive lymph nodes associated with this approach make it less appealing than wide excision and observation. Multiple retrospective studies suggest a survival advantage as high as 25% for patients undergoing elective node dissection in the setting of clinically negative nodes, as opposed to delayed node dissection for clinically evident nodal metastases. Although two randomized prospective studies failed to demonstrate a survival advantage in patients undergoing elective node dissection, as compared with those having wide excision alone, both studies were criticized for their design [1,2].

Drs. North and Spellman concisely review the role of sentinel node biopsy in the management of patients with malignant melanoma and provide an excellent summary of the current state of this technique. A number of comments should be made about this review. These comments relate to (1) the technical aspects of the procedure and (2) its clinical indications.

The use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been

BETHESDA, Md--Research supported by the National Institutes of Health and the National Cancer Institute has led to discovery of a tumor-suppressor gene involved in basal cell carcinoma.

Dr. Trimble's review of female genital tract melanomas provides a well-organized summary of the published information on these rare cancers. His inclusion of the two recent population-based samples from the United States and Sweden [1,2] is particularly useful because all of the available data on genital tract melanomas comes from long-term retrospective case reviews. The cited incidence rates calculated in the studies represent the first legitimate estimates of the incidence of these uncommon cancers.

Melanomas of the vulva and vagina comprise less than 2% of melanomas in women. Although their biologic behavior appears to be similar to that of cutaneous melanoma, vulvar and vaginal melanomas appear to have a

WASHINGTON--Final approval by the National Cancer Institute of the largest ever melanoma vaccine trial is near, John M. Kirkwood, MD, of the University of Pittsburgh, said at the American Association for Cancer Research (AACR) meeting. "I think before the summer is through, we should see this trial initiated," added Dr. Kirkwood, principal investigator for the study.

ASCO--A randomized ECOG study of patients with high-risk melanoma showed significant gains in overall and recurrence free survival for adjuvant high-dose interferon alfa-2b (Intron), but also showed that the high-dose regimen has significant side effects. However, a new quality of life analysis suggests that, for most patients, the benefits of interferon clearly offset its toxicity, Bernard Cole, PhD, of Brown University, said at an ASCO scientific session.

DURHAM, NC--A researcher at Duke Comprehensive Cancer Center has pioneered the use of CD-ROM technology to preserve a photographic record of the skin and to detect the earliest signs of melanoma.

Approximately three-fourths of all skin cancer-associated deaths are caused by melanoma. During 1973 to 1991, the incidence of melanoma increased approximately 4% each year. In addition, the incidence of melanoma is increasing faster than that of any other cancer. To characterize the distribution of deaths from melanoma in the United States, the CDC analyzed national mortality data for 1973 through 1992. This report by the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, summarizes the results of that analysis.

MADISON, NJ--Schering-Plough Corporation's Intron A for Injection (interferon alfa-2b, recombinant) has received FDA clearance for a new indication as adjuvant treatment to surgery in malignant melanoma patients at high risk for systemic recurrence.

University of Pittsburgh Cancer Institute (UPCI) investigators have begun vaccinating people with advanced melanoma using molecules that are overexpressed in melanoma cells.

BUENOS AIRES--The techniques of lymphatic mapping, sentinel lymph node biopsy, and polymerase chain reaction (PCR) determination of occult metastases promise to provide a more accurate staging of the melanoma patient with more conservative surgery. This could save the health-care industry dollars and save patients the morbidity and expense of complete node dissection, Douglas Reintgen, MD, said at the Sixth World Congress on Cancers of the Skin.

BUENOS AIRES--The surgical care of the melanoma patient is in flux because of new data showing that complete nodal staging can be obtained with the technique of lymphatic mapping and sentinel lymph node biopsy, said speakers at a plenary session at the Sixth World Congress on Cancers of the Skin.

BUENOS AIRES-Ultraviolet (UV) radiation contributes to skin cancer induction not only by transforming normal cells to cancer cells but also by impairing the host immune response to skin cancer, said Daniel Yarosh, PhD, president of Applied Genetics, Inc., Freeport, NY.

The history of systemic treatments for advanced cutaneous melanoma, which is reviewed thoroughly in the paper by Anderson et al, can best be characterized as a series of unrealized hopes.

The treatment of advanced cutaneous melanoma remains disappointing. Single-agent cytotoxic drugs usually produce response rates of less than 20%, though newer agents, particularly fotemustine and temozolomide, show some promise, especially in patients with brain metastases.