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D S Reintgen

Publications and source records attributed to D S Reintgen.

At least 109 records · Page 6Linked to original sources
PubMed1992

The current management and prognosis of acral lentiginous melanoma.

A computer-aided retrospective analysis was performed on 359 patients with stage I and II melanoma at the time of diagnosis (disease confined to the primary melanoma), at the University of South Florida (Tampa, FL). Eighteen patients were identified with primary melanoma in acral locations, most being acral lentiginous melanoma. A comparison of actuarial survival curves of patients with melanoma in four different locations (acral, head and neck, trunk, and other extremity site) was performed. The patients with melanoma in acral locations did not have a statistically different actuarial survival than those with primary melanoma in other sites. When actuarial disease-free survival curves were constructed, however, acral primary melanoma had a shorter interval to recurrence than those located on the trunk or other extremity sites. Differences between actuarial disease-free survival for the head and neck and for acral primary sites were not significant. To identify prognostic factors responsible for the decreased disease-free survival of the acral lentiginous population, a regression analysis was performed. Three prognostic factors were analyzed for stage I and II melanoma, including Breslow tumor thickness, ulceration of the primary lesion, and primary site location. In the univariate analysis, with each prognostic factor acting independently, tumor thickness (p less than 0.01) and ulceration (p = 0.02) were significant variables influencing the disease-free interval. Primary site did not, however, add prognostic information to the model (p = 0.54). A stepwise multivariate analysis confirmed this finding.

Female↗
PubMed1991

Touch preparation cytology of breast lumpectomy margins with histologic correlation.

Residual microscopic disease after lumpectomy for breast cancer may cause significant local recurrence. We evaluated one hundred fourteen consecutive breast lumpectomy margins in this study by touch preparation cytology. Cytologic preparations were intraoperatively correlated with gross and frozen section results and subsequently with permanent histologic sections of representative margins. Three specimens were cytologically unsatisfactory and 86 yielded benign findings, while material suggestive or diagnostic of malignancy was obtained from 25 specimens. Gross, frozen section, and permanent histologic margins were positive in 10, 17, and 22 cases, respectively. There were three false-positive touch preparation cytologic results, while frozen section specimens were false-negative in five cases. Sensitivity and specificity of touch preparation cytology were 100% and 96.6%, respectively, with a diagnostic accuracy of 97.3%. Touch preparation cytologic examination rapidly and reliably evaluates lumpectomy margins and overcomes sampling errors and artifacts related to frozen section evaluation. This technique currently complements frozen section evaluation of lumpectomy margins as part of a protocol aimed at reducing local recurrence of breast cancer.

Adult↗
PubMed1991

Detection of submicroscopic lymph node metastases in patients with melanoma.

A cell culture technique was developed to investigate submicroscopic lymph node metastases in patients with stage 1 or 2 malignant melanoma. Lymph nodes were isolated from standard dissections and bivalved. Half of the node was evaluated by routine histopathologic examination, while the other half was processed and placed into tissue culture. Three hundred twenty-three lymph nodes were collected from 41 patients. The cell culture technique identified 155 of 323 lymph nodes containing micrometastases, while only 20 of 323 lymph nodes tested positive with routine histochemical processing. Nine patients were upgraded from stage 1 or 2 to stage 3 disease after micrometastases were identified in lymph node cultures. Identification of melanoma was confirmed by cytologic examination, immunohistologic staining, and the presence of GD3 ganglioside and 250-kd glycoprotein melanoma-associated antigens. This study provides evidence that the culture of lymph nodes is a sensitive method for the detection of micrometastases. In addition, this procedure may change prognosis and identify candidates for adjuvant therapies.

Antibodies, Neoplasm↗
PubMed1990

Malignant melanoma arising during pregnancy. A study of 100 patients.

Melanoma is often diagnosed in young adults, a significant proportion of whom are women of child-bearing age. The prognosis of women diagnosed with melanoma during a pregnancy continues to be debated. One hundred patients, ages 19 to 40 years, have been identified who were pregnant at the time of diagnosis of their melanoma. All were treated with local excision. Sixteen per cent underwent elective lymph node dissections. Immunotherapy was administered to 83% of patients. Mean follow-up was 6.8 years from the date of diagnosis. The patients were compared to an age-matched group of 86 women who were not pregnant at the time of diagnosis. Overall mortality during the follow-up period was 25% in the pregnant group and 23% in the control group. Among the pregnant group, there was an increased incidence of lymph node metastases during the follow-up period (39% versus 26%, p = 0.053). Among stage I patients, there was a significantly shorter DFI for the pregnant group (p = 0.039), with 50% of pregnant patients and 67% of control patients free of disease at 10 years. Similarly, among stage 1 patients, the time to development of lymph node metastases was shorter in the pregnant group (p = 0.021). Multivariate analysis demonstrated that pregnancy at diagnosis was significantly associated with the development of metastatic disease (p = 0.008), when controlling for tumor site, thickness, and Clark level. Patients who developed melanoma during pregnancy did not, however, have a significant decrease in survival.

Adult↗
PubMed1989

Juvenile malignant melanoma.

Malignant melanoma in children and adolescents is a rare phenomenon. During a retrospective computer-aided chart review, 78 patients less than 20 years of age were identified who had the diagnosis of malignant melanoma. This accounted for 1.8 per cent of all the melanomas registered at the University Melanoma Clinic. Fifty-one per cent were females, and all the patients were white. Most of the lesions were found on the primary areas of the trunk and extremities. Sixty-seven per cent of the melanomas were of the superficial spreading type, and 82 per cent were invasive to Clark level III and IV. The range of tumor thickness was 0.32 to 5.22 millimeters, with a mean of 1.76 millimeters. Similar population characteristics were noted in the adult and juvenile populations. Controlling for the two most powerful prognostic factors for Stage I melanoma, that is, ulceration and tumor thickness, the actuarial survival times between the two population groups were similar. The median survival times in the adult and juvenile population were 12.9 and 11.9 years, respectively (p = 0.54). There was a trend toward a shorter disease-free interval in the juvenile population. The five year disease-free interval was 65 per cent for adults with melanoma compared with 57 per cent for juveniles with malignant melanoma (p = 0.16). Multiple regression analysis failed to reveal age less than 20 years to be an independent prognostic factor for the development of metastases or over-all survival time. Recurrent disease was observed in 46.2 per cent of juveniles with melanoma who were initially Stage I at diagnosis. Eighty per cent of the relapses occurred in either the local skin or regional lymph nodes. Although malignant melanoma is rare in populations of patients younger than 20 years of age, clinicians should be aware that melanoma does occur in juveniles. With an aggressive approach to surgical therapy, survival rate is comparable with that of the adult population.

Adolescent↗
PubMed1988

Lethal "thin" malignant melanoma. Identifying patients at risk.

Thin melanomas can metastasize and be lethal. The purpose of this review was to identify negative risk factors in patients with melanomas less than 0.76 mm thick. Six hundred and eighty-one (681) such patients are reviewed in this study. Of those referred without metastatic disease (583 patients), metastases developed in 4.8% after a mean followup of 3.6 years. Of those referred with metastatic disease (98 patients), mortality was 35% after a mean followup of 5.9 years. Male patients (p less than 0.04) and patients with axial primaries (p less than 0.05) were at an increased risk of metastasis. Severe histologic regression was present in 40% of the primary lesions that metastasized and in only 17% of similar lesions that did not (p less than 0.001). Increased age was associated with increased local skin metastases, but not with increased nodal or distant metastases. A prognostic model was designed, using two clinical risk factors (axial primary site and male sex) and two histologic risk factors (Clark's Level IV and severe histologic regression). The prognostic model identified a low-risk population--women with extremity primaries--with an actuarial risk of metastasis at 10 years that was less than 3%. Patients with either (1) both clinical risk factors or (2) one clinical risk factor and one histologic risk factor were identified as high-risk patients. Their actuarial risk of metastasis was 11% at 5 years and 22% at 10 years (p = 0.0084). Identifying high-risk and low-risk patients with thin melanomas may improve guidelines for the application of adjuvant therapies to this population.

Adult↗
PubMed1988

Juvenile malignant melanoma of the head and neck.

Malignant melanoma of the head and neck is a potentially lethal disease and considered rare among juveniles. Treatment patterns have historically been dictated by experience with adults, however a paucity of data is available to determine the natural history and treatment guidelines for juveniles and children with malignant melanoma. Therefore a retrospective computer-aided analysis of patients less than 20 years of age having malignant melanoma were obtained from the records of 4,843 patients with malignant melanoma recorded from 1972 through 1986. Eighty-seven patients were identified from this group with 17 patients having primary malignant melanomas confined to the head and neck. Parameters evaluated were age at diagnosis, sex, type of melanoma, Clark Level, Breslow depth of invasion, pathologic classification, site of primary, nodal status at diagnosis, surgical treatment, recurrence rate and site of recurrence, and follow-up status. Two of 17 patients had stage II disease and were treated with wide local excision and therapeutic radical neck dissection. Fifteen of 17 patients initially presented with stage I disease were treated with wide local excision. Two of these patients underwent elective radical neck dissection both of which proved to have positive occult nodal disease. Both are alive without evidence of disease 2 1/2 to 7 years later. Of the 13 patients who were initially treated with only wide local excision, nine patients developed local (3), regional (3), or systemic (3) disease within 3 months to 9 years from the date of diagnosis. Seven of the nine died of their disease 5 months to 20 years later. When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survival time, but shorter disease-free intervals, even though the adult population had a higher percent of poor prognostic indices (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survival rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive approach for better control of local and regional disease and, hopefully, survival.

Adolescent↗
PubMed1987

Prognosis for recurrent stage I malignant melanoma.

The outcome of patients with stage I malignant melanoma has been well assessed in terms of prognostic factors and their effect on survival; however, little is known of the recurrence patterns of cutaneous melanoma or the survival of these patients subsequent to recurrence. A retrospective, computer-aided chart review identified 4185 patients with melanoma who had stage I disease clinically. During a follow-up period of one to 14 years, 35.9% suffered a recurrence. Melanoma of the trunk (37.8%) and head and neck area (46.1%) had an increased incidence of recurrent metastases compared with melanoma of the extremities (29.8%). Local regional metastases accounted for 62.5%, 77.3%, and 85.6% of the recurrences in the head and neck, trunk, and extremity primary sites, respectively, with 65% of the relapses occurring within the first three years. Actuarial five-year survival rates of patients who had recurrent disease were significantly decreased compared with those of patients who had no evidence of metastases during their clinical course. A multivariate analysis was performed to estimate the survival of patients after recurrence. One may use this mathematical model to predict the outcome of individual patients after recurrence and provide a more rationally based prognosis for them and their families.

Adult↗
PubMed1985

Malignant melanoma and pregnancy.

Confusion exists concerning the influence of pregnancy on survival in patients with malignant melanoma. To evaluate this problem a retrospective computer-aided study was performed of women in the child-bearing years treated for Stage I cutaneous melanoma at the Duke University Comprehensive Cancer Center. Fifty-eight women were identified who had melanoma arise during pregnancy (Group 1) and 43 patients were noted who became pregnant within 5 years of diagnosis of their melanoma (Group 2). Appropriate control groups matched for the clinical variables of age, primary site, and stage of disease and the pathologic variables of Clark's Level, tumor thickness, ulceration, and histologic type were selected from the cohort of 2938 melanoma patients seen at Duke. Actuarial survivals for Group 1 and 2 patients did not differ from their respective controls, although the small number of deaths in each group resulted in wide confidence intervals. When actuarial disease-free intervals were plotted, there was a significant difference between women who had melanoma develop during pregnancy when compared to their controls (P = 0.04). In a multivariate regression analysis, after adjustment for the influence of the more significant prognostic factors for Stage 1 melanoma, including Clark's Level, ulceration and tumor thickness, the effect of pregnancy on disease-free interval became more apparent (P = 0.02). No difference in actuarial disease-free interval was noted in the melanoma patients who elected to become pregnant within 5 years of diagnosis (P = 0.31). A multivariate regression analysis confirmed this finding. These data indicate that although an intercurrent melanoma during pregnancy has a worse prognosis than the control groups, once a woman has been diagnosed as having a cutaneous melanoma, a subsequent pregnancy has no effect on recurrence rate or survival.

Actuarial Analysis↗
PubMed1984

Radiologic, endoscopic, and surgical considerations of melanoma metastatic to the gastrointestinal tract.

Malignant melanoma is the most common malignancy to metastasize to the gastrointestinal tract. In a retrospective computer-assisted data search of over 2500 patients with melanoma registered over the past 10 years, 110 patients have been identified to have premortem gastrointestinal metastatic disease (metastatic disease identified at least 6 months before death). The small intestine (35%), colon (14.5%), and stomach (7%) are the most common sites for metastases. Polypoid or ulcerating masses and intramucosal nodules are typical radiologic presentations for gastric and colonic lesions, while over 50% of the small bowel metastases are polypoid masses that many times act as leading points for intussusception. Endoscopic studies are helpful in the preoperative diagnosis of these lesions. In a subset of 38 patients with symptomatic small bowel metastatic disease, complete resections were performed in 26% of patients, with palliative bypasses being performed in 40%, despite the fact that over 50% of the patients had documented visceral metastasis in other body sites. The operative morbidity rate was 15% with no operative deaths. Ninety percent of patients gained relief of symptoms, and overall survival from the time of confirmed small bowel disease averaged 17.3 months, with a range of 6 months to 9 years. It would seem that patients with melanoma with gastrointestinal metastatic disease can benefit from aggressive radiologic and endoscopic procedures for diagnosis and staging. Only through surgical interventions for symptomatic gastrointestinal disease can the quality of life be improved and life expectancy be extended.

Colonic Neoplasms↗
PubMed1984

Sex related survival differences in instances of melanoma.

While data concerning melanoma survival differences between the sexes as they relate to anatomic site, stage and age is scattered throughout the literature, few single studies on one large population of patients with melanoma have specifically addressed all the confounding variables proposed to account for such sex related survival differences. Data were collected for 1,489 patients with melanoma observed at Duke University Comprehensive Cancer Center. Females had a more favorable prognosis than males. This survival difference could not be fully explained by differences in the anatomic site of the primary, Clark level of invasion, histologic type or ulceration of the primary lesion or age at diagnosis between males and females. There is growing epidemiologic and biochemical evidence that melanoma may be affected by sex hormones.

Adolescent↗
PubMed1983

Immunodiagnosis of tumors in vivo using radiolabeled monoclonal antibody A2B5.

Recently a murine monoclonal antibody (A2B5) has been described that reacts with a membrane associated GQ ganglioside common to peptide secreting normal cells and tumors. In vitro binding data demonstrated the presence of this ganglioside on neurons, adrenal medulla, and pancreatic islets, along with neuroendocrine tumors such as insulinomas, pheochromocytomas, melanomas and neuroblastomas. Negative binding has previously been shown for tissue sections from liver, kidney, colon, lung, stomach, and tumors not derived from the neural crest. Because of the specificity at A2B5 in vitro, this monoclonal antibody was labeled with 131I for in vivo tumor localization studies. Daily radionuclear scans were obtained in 5 KX rats bearing the radiation induced rat insulinoma with disappearance of the label from the blood pool and concentration in the tumor so that by the fourth day, the only activity present by scan was in the insulinoma. Tissue-counting data showed tumor/blood ratios (av +/- SE, 1.29 +/- 0.25) of A2B5 activity two to ten times the average activity found in other organs (0.28 +/- 0.05). No tumor concentration of the control nonspecific monoclonal antibody P3X63 was evident (0.27 +/- 0.04). In addition A2B5 also localized to five different human melanoma cells lines grown in nude mice with high tumor/blood levels (1.04 +/- 0.27) compared to normal tissues (0.32 +/- 0.05) (P = .0005), while no localization is seen in nudes carrying osteosarcomas, colon, bladder, and renal cell carcinomas. In addition antibody A2B5 did not concentrate in any normal tissue though the antigen is present on several. The finding that A2B5 reacts across species lines (mouse, rat, man) lends itself to obvious diagnostic and therapeutic possibilities.

Adenoma, Islet Cell↗
PubMed1983

Efficacy of elective lymph node dissection in patients with intermediate thickness primary melanoma.

One of the most controversial areas in the management of malignant melanoma concerns the efficacy of prophylactic lymph node dissection. During a retrospective computer-aided data review of over 3000 melanoma patients referred to the Duke University Cancer Center, 613 patients with complete staging along with surgical and pathologic data, having trunk and extremity melanoma, were identified with Breslow thickness in the range of 0.76 to 4.0 mm. One hundred eighty-seven of these clinically node-negative patients received an elective lymph node dissection (WLE/ND). The remaining patients were treated only with an initial wide local excision (WLE) at the time of diagnosis of their melanomas. There was no difference in age at diagnosis or male-female ratio between the treatment groups. A higher percentage of the WLE/ND group (36% vs. 31%) showed ulceration of their primary lesions and a greater mean tumor thickness (1.81 +/- 0.80 mm vs. 1.60 +/- 0.73 mm) than the WLE patients. Despite the force of these two adverse prognostic factors in the WLE/ND group, only ten deaths (5%) have occurred in the elective lymph node group compared to 51 (12%) in the control group. Using a multifactorial analysis to control for the prognostic contribution of the two most informative variables in stage I melanoma, Breslow thickness and ulceration, WLE/ND had an independent favorable effect on survival (p = 0.01). There was no apparent additional benefit to lymph node dissection in patients whose primary lesion measured less than 0.76 mm or greater than 4.0 mm in thickness. The surgeon may use survival estimates with and without elective node dissection based on a prognostic equation ("prognostigram") as a quantitative aid to treatment planning.

Actuarial Analysis↗
PubMed1983

Functional and morphologic changes associated with insulinoma transplantation into diabetic rats.

Because of the technical difficulties encountered with human islet cell transplantation, alternatives toward supplying the juvenile diabetic with an endogenous insulin source are sought. With the use of a streptozotocin-induced diabetic rat model, it was found that by transplantation of a benign insulinoma, the glomerular deposition of material stained by the periodic acid-Schiff method, IgG, IgM, and C3 may be prevented. This effect was found only when transplantation of the insulin-producing tumor occurred within 2-4 weeks of the induction of diabetes. The data suggest that successful insulinoma engraftment can prevent the glomerular mesangial lesions from developing.

Adenoma, Islet Cell↗
PubMed1983

Lymphoscintigraphy for malignant melanoma. Surgical considerations.

Lymphoscintigraphy using technetium-99m atimony sulfur colloid was performed in 22 patients with melanoma referred to Duke University Comprehensive Cancer Center in an attempt to identify patterns of regional lymphatic drainage. Scans from six patients revealed lower extremity lesions with three located below the knee, one in the popliteal space, and two others proximal to the knee joint. Despite the location of the primary, all scans but one showed initial drainage to the inguinal nodes bypassing the popliteal lymph node group. Of the three patients who had primary melanoma of the posterior scalp, the lymphatic drainage was directed to the posterior cervical nodes. No drainage to the parotid nodes or anterior neck nodes was visualized. The knowledge gained from lymphoscintigraphy resulted in posterior neck dissections instead of the standard anterior neck dissection and superficial parotidectomy. In areas of ambiguous lymphatic drainage from the trunk, radiocolloid scanning can identify areas at risk for developing metastatic disease. Six lesions within 5 cm of the midline demonstrated bilateral axillary or groin drainage in 83 per cent of the patients. For two lesions near Sappey's line colloidal uptake to the ipsilateral axilla and groin was the rule. After a 3-year follow-up, during which time 70 to 90 per cent of lymph node metastases are predicted to occur, no nodal metastases were ever documented in areas that did not show colloidal uptake. No correlation was found between amount of radiolabel in positive compared to negative nodes, although those nodes that were completely replaced by tumor contained no 99mTc activity and were negative on scanning.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Metastatic malignant melanoma with an unknown primary.

Patients who are diagnosed initially as having metastatic melanoma with no known cutaneous, mucosal or ocular primary are a perplexing clinical problem. In the Duke University Melanoma Clinic, 124 patients have been identified as meeting the criteria of an unknown primary melanoma. This represents 4.8 per cent of the total melanoma population seen at this institution. There were 2.5 times as many males as females with an average age at diagnosis of 47.9 years. Regional lymph node disease was the most common presentation with 64 per cent of the patients falling into this category. Those patients who showed initial evidence of hematogenous spread of their melanoma had a worse prognosis than their counterparts who manifested primarily lymphatic spread. When compared with control population groups with known primary melanoma, the unknown primary group had equal survival emphasizing that surgical treatment should be similar for both groups.

Adolescent↗
PubMed1982

Malignant melanoma in black American and white American populations. A comparative review.

Malignant melanoma, a type of cancer that accounts for 1% to 3% of all malignant neoplasms in 20 times more frequent in the American white than black population. During a computer-aided retrospective chart review of more than 2,500 patients with melanoma being followed up at the Duke University Comprehensive Cancer Center, 31 blacks have been identified. Primary lesions of the foot were predominant in blacks with melanoma, and a high percentage of these were classified pathologically as acral lentiginous primary lesions. Black patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than their white counterparts. Five-year survival for the total black population was 23%. Blacks had a significantly worse prognosis than the white population when a comparison with the total group was made that was controlled for sex, age, site of primary lesion, stage of disease at presentation, and Clark level of primary melanoma lesion. This emphasizes the aggressive nature of this disease in the American black.

Adolescent↗