Pathological factors influencing excision of tumours in the head and neck. Part II.
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Biomedical subjects
Publications and source records attributed to A Levene.
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This review deals with difficulties of diagnosis in cutaneous malignant melanoma encountered by histopathologists of variable seniority and is based on referred material at The Royal Marsden Hospital over a 20-year period and on the experience of more than two-and-a-half thousand cases referred to The World Health Organisation Melanoma Unit which I reviewed when chairman of the Pathologists' Committee. Though there is reference to the differential diagnosis of primary and metastatic tumour, the main concern is with establishing the diagnosis of primary melanoma to the exclusion of all other lesions. An appendix on recommended diagnostic methods in cutaneous melanomas is included.
In man the epidermis is the final destination for most of the melanocytes which are of neural crest origin, and they migrate to a variety of sites. Dermal melanocytic distribution, conspicuous in some lower animals, has a very restricted normal distribution in man, and of the variety of anomalies which exist the blue naevus is the most frequently encountered. It is comparable to the common melanocytoma of dog and hamster. More widespread dermal melanocytoses are rare, and a unique case in which death from melanoma supervened, recently recorded by the author, is an example of a syndrome the only parallel to which appears to be equine melanotic disease, a disorder of aging, greying horses. It is argued on comparative grounds that the newly described syndrome and equine melanotic disease are examples of a neurochristic disorder involving the cephalad segments and dermal melanocytes.
A detailed account is given of a progressive, punctate dermal melanocytosis which, commencing in childhood, terminated in the fifth decade as disseminated melanoma with no primary site discoverable. The terminal findings were characterized by prominent melanophagia. In the author's opinion there are resemblances between the unique condition described and a form of equine melanotic disease.
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One hundred and seventeen patients with advanced squamous cell carcinoma of the head and neck were randomised between two combination schedules, one with and the other without adramycin. Responses (more than 50% tumor regression) were 67% overall with 63% responding to the combination without adriamycin and 82% responding to the schedule containing it. The increase in response rate seen with the addition of adriamycin is not statistically significant. Prior radiotherapy reduced the likelihood of response to chemotherapy.
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