Search PubMed⌕ Search

Biomedical subjects

H M Shaw

Publications and source records attributed to H M Shaw.

At least 73 records · Page 4Linked to original sources
PubMed1985

Histogenesis of malignant melanoma with an adjacent component of the superficial spreading type.

There has been a world-wide exponential increase in the incidence of thin malignant melanoma. At the Sydney Melanoma Unit, the proportion of patients diagnosed as having superficial spreading melanoma has more than doubled from 33% prior to 1960 to 78% during 1980-83. A study was made of the non-invasive component of malignant melanoma with an adjacent non-invasive component of the superficial spreading type in an attempt to elucidate the pathogenetic mechanisms involved in these changing trends. In this study on 723 cases of melanoma with a superficial spreading component, there was evidence that 39% originated in a precursor lesion. In the remaining 61%, the adjacent superficial spreading component consisted of melanoma in situ, suggesting that these were melanomas from the beginning. The latter lesions were thinner and had a lower degree of mitotic activity than melanomas commencing in a precursor lesion. Despite the large increase in incidence of superficial spreading melanomas and the shift to thinner lesions over time, there appeared to be no difference in the proportion of lesions commencing de novo to those commencing in a precursor lesion. This suggests that the precursor lesion may be of genetic origin.

Humans↗
PubMed1985

Prognostic histopathological factors in malignant melanoma.

An analysis of prognostic factors in 4000 patients with cutaneous malignant melanoma at the Sydney Melanoma Unit and the University of Alabama in Birmingham has demonstrated that the histological features of the primary melanoma become less predictive of survival the more advanced the disease becomes. Thus, whilst 4 features of primary lesions were independent predictors in localized disease (tumour thickness, ulceration, level of invasion and regression), only one of the stronger ones (ulceration) remained predictive in patients with regional lymph node metastases. Once distant spread was evident, there were no parameters of the primary lesion that predicted survival. Thus, in patients with advanced disease prognosis was dictated by the extent of metastatic involvement: the number of positive lymph nodes in stage II patients and the number and location of metastatic sites in stage III patients.

Humans↗
PubMed1985

Efficacy of elective lymph node dissection in 2,347 patients with clinical stage I malignant melanoma.

The results of a largely prospective but non-randomized study of 2,347 patients with clinical Stage I malignant melanoma have demonstrated that there are certain subgroups of patients who benefit substantially from ELND. Men with lesions of intermediate thickness (1.6 to 3.0 millimeters) benefited most from ELND, both in terms of disease-free and total survival rates. Ten year survival rates in patients who underwent ELND were more than 40 per cent higher than the rates in patients who underwent WE. Although total survival rates were not improved in patients with the thickest lesions (those in excess of 3.0 millimeters) disease-free rates in these patients were considerably higher after ELND. Women with lesions of the extremities thicker than 1.5 millimeters had significantly improved disease-free and total survival rates after ELND (ten year survival rates of up to 37 per cent higher after ELND). No women with lesions of the trunk appeared to benefit from this surgical procedure.

Female↗
PubMed1984

Head and neck melanoma in 534 clinical Stage I patients. A prognostic factors analysis and results of surgical treatment.

Single and multifactorial analyses were used to evaluate prognosis and results of surgical treatment in 534 clinical Stage I patients with head and neck cutaneous melanoma treated at the University of Alabama in Birmingham (U.S.A.) and the University of Sydney (Australia). This computerized data base was prospectively accumulated in over 90% of cases. Melanomas were about equally distributed between men and women. They were located on the skin of the face in 47%, neck in 27%, scalp in 13%, and the ear in 13% of patients. Both the results of the prognostic factors analyses and the surgical treatment demonstrated that lentigo maligna melanoma (LMM) was distinct from the other two growth patterns, superficial spreading melanoma and nodular melanoma (SSM and NM). In a multifactorial analysis of the 453 patients with SSM and NM, the dominant prognostic variables were tumor thickness (p less than 0.00001), anatomic subsite (p = 0.0213), and ulceration (p = 0.0289). Patients with melanomas on the scalp or neck subsites fared worse than those with tumors located on the face or ear. The results differed for LMM, where thickness was not a significant predictor of survival, and the most dominant prognostic variable was ulceration (p = 0.0042). Local recurrence rates were low, being 2.4% for tumors less than 2.5 mm in thickness, but were 12.3% for tumors greater than or equal to 4.0 mm in thickness. Patients with SSM and NM lesions located on the head and neck had a lower survival rate than those with extremity melanomas in every tumor thickness category, although only those in the 0.76 to 1.49 mm thickness subgroup were significantly different (p = 0.0007). After 5 years of follow-up, patients who underwent an elective lymph node dissection for SSM and NM with a thickness range of 1.5 to 3.99 mm had a better survival (72%) than patients with melanomas of equivalent thickness whose initial treatment was wide excision alone (45%). LMM had a less aggressive biologic behavior compared to SSM or NM and was treated more conservatively. Thus, LMM lesions had an 85% 10-year survival rate with wide excision only, and there was no significant improvement in survival with ELND. Growth patterns, tumor thickness, ulceration, and anatomic subsites should be considered when evaluating risk factors and when making treatment decisions in head and neck melanoma patients.

Head and Neck Neoplasms↗
PubMed1983

Changing trends in cutaneous melanoma over a quarter century in Alabama, USA, and New South Wales, Australia.

Clinical and pathologic characteristics of melanoma were compared among 1647 clinical Stage I patients treated at the University of Alabama in Birmingham (USA) and The University of Sydney (Australia) between 1955 and 1980 to determine what changes occurred over a quarter century. Over this period, the number of patients treated annually has increased substantially. There was a steady increase in the proportion of patients presenting with localized disease (clinical Stage I). Melanomas became thinner, less invasive, less ulcerative and thus more curable. They also exhibited more of a radial growth phase. The median thickness of melanomas decreased in Australia from 2.5 mm prior to 1960 to 1.1 mm during the period 1976 to 1980, while in Alabama it has decreased from 3.3 to 1.4 mm. There was a significant increase in melanomas located on the trunk in males and a corresponding decrease in male head and neck melanomas. No significant change in the site distribution was observed for any major anatomical area on female patients. There were minimal differences in the incidence of both clinical and pathologic parameters among melanoma patients in Alabama, USA and in New South Wales, Australia even when accounting for their year of diagnosis. Long-term survival rates in patients with localized disease were found to increase slightly during the 25 year time frame of this analysis. The changes that have occurred are likely due to earlier diagnosis and changes in the biological nature of the disease.

Adult↗
PubMed1983

Prognostic significance of a polypoid configuration in malignant melanoma.

In a review of 2296 patients with malignant melanoma, the overall incidence of a polypoid configuration was 21.5%. A markedly higher proportion of patients with polypoid melanoma than with dome-shaped melanoma first presented for melanoma treatment already with metastases (i.e. clinical stage II or III). In patients with localized disease, more men than women tended to present with polypoid lesions. The majority of these lesions were of the nodular histogenetic type, greater than 3.0 mm thick and ulcerated. When patients with polypoid and dome lesions were matched according to three known important prognostic determinants: sex of patient, the thickness of their primary lesion and whether their lesion showed microscopic evidence of ulceration, no consistent differences in prognosis were detected between patients with polypoid and dome lesions. Thus it appeared that the poor prognosis for patients with polypoid lesions was not attributable to the configuration of their lesion per se but primarily due to the fact that they were typically thick, ulcerated lesions.

Adult↗
PubMed1983

Prognosis in patients with thin malignant melanoma: influence of regression.

It has been suggested that patients with thin malignant melanoma displaying evidence of histological regression may have a poor prognosis. In the present study, the case histories of 353 patients with clinical stage I cutaneous malignant melanoma up to 0.7 mm thick were reviewed to determine if either active or past regression in these lesions was a poor prognostic sign. Lesions were reported as displaying evidence of partial regression if either (a) a portion of the melanoma had a heavy lymphocytic infiltrate associated with loss of tumour cells or the presence of degenerating tumour cells, or (b) a portion of the melanoma was replaced by vascular fibrous tissue with or without pigment-containing phagocytes. The incidence of regression in this study (58%) was similar to that reported in another recent large study on thin lesions (53%). Only slightly more regressed than unregressed lesions metastasized (8% versus 5% respectively). A high proportion of first recurrences from these thin lesions developed at sites remote from the primary lesion (lung, bone or in subcutaneous tissues or lymph nodes wide of the line of spread). However, the presence or absence of regression in thin lesions did not appear to influence the site of first recurrence. Cumulative 10-year survival rates for patients whose lesions displayed or did not display evidence of either active or past regression were nearly identical.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

The female superiority in survival in clinical stage II cutaneous malignant melanoma.

Five-year survival rates were similar in men and women with nodal metastases from malignant melanoma (clinical Stage II). This is in contrast to our previous studies on patients with localized disease (clinical Stage I) which indicated a marked female superiority in survival. To seek explanation for this, we examined in these patients with regional lymph node metastases, four factors which we previously showed to be of prognostic importance in patients with localized disease: (1) Age of patient: overall survival rate in Stage II women was markedly reduced due to extremely poor prognosis for postmenopausal women; (2) Site of primary lesion: Stage II women had a preponderance of extremity lesions, but these were not more prognostically favorable anatomic locations than axial locations; (3) Tumor thickness: women with metastatic malignant melanoma had a significantly higher proportion of very thick lesions than men; and (4) Evidence of tumor regression: although men with very thin regressing tumors had a poor prognosis, there were too few lesions of this thickness in patients with Stage II melanoma to markedly influence overall survival. It was concluded that although overall five-year survival rates in men and women with clinical Stage II malignant melanoma were similar, if these patients were matched by age and thickness of primary lesion, a female superiority in survival did exist for young patients with very thick tumors.

Age Factors↗
PubMed1982

Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: results of surgical treatment in 1319 patients.

A retrospective study was made of 1319 patients with cutaneous primary malignant melanoma and regional lymph nodes clinically free of disease, whose first definitive surgical treatment was either (a) wide excision of the primary lesion (WE) or (b) wide excision of the primary lesion plus a prophylactic lymph node dissection (PLND). Patients were stratified according to three dominant prognostic factors, as revealed by multifactorial analyses: sex of patient, the anatomical site and thickness of the primary lesion. Of 380 patients who underwent PLND for lymph nodes clinically free of disease, there was microscopic evidence of nodal metastases in 5 per cent. Despite this, prognosis in these patients was nearly twice as good as in those patients undergoing lymph node dissection for clinically involved nodes. Five-year survival rates for all those clinical stage I patients with lesions less than 0.8 mm thick were high irrespective of initial surgical treatment. In men with lesions of intermediate thickness (particularly 1.6-3.0 mm), survival rates for those undergoing PLND were considerably higher than for those undergoing WE. There were no survival benefits of PLND in men with lesions thicker than 3.0 mm. This was in contrast to the situation in women, where PLND was indicated for patients with the thickest lesions. This study has defined three parameters which can serve as useful practical guides for selecting alternative surgical procedures in the management of clinical stage I cutaneous malignant melanoma.

Adult↗
PubMed1982

A comparison of prognostic factors and surgical results in 1,786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia.

Twelve clinical and pathologic parameters were compared in two series of Stage I melanoma patients treated at the University of Alabama in Birmingham, USA (676 patients) and at the University of Sydney in New South Wales, Australia (1,110 patients). Actuarial survival rates were virtually the same at the two institutions over a 25-year follow-up period. The incidence of thin melanomas (less than 0.76 mm) was also similar at both geographic locations (25% vs. 26%). Other similarities of these two patient populations included the following: 1) tumor thickness (Breslow Microstaging). 2) level of invasion (Clark Microstaging), 3) surgical results, 4) sex distribution, and 5) age distribution. The greatest differences between the two patient populations were their 1) anatomic distribution, 2) growth pattern, and 3) incidence of ulceration. The trunk was the most common site of melanoma, and occurred more frequently among Australian patients (37% vs. 28%). A multifactorial analysis (Cox's regression model) was then performed that included a comparison of the two institutions as a variable (Alabama vs. Australia). The dominant prognostic factors (p less than 0.0001) were 1) ulceration, 2) tumor thickness, 3) initial surgical management (wide excision +/- node dissection), 4) anatomic location, 5) pathologic stage (I vs. II), and 6) level of invasion. The benefit of elective lymph node dissection was demonstrated in both series for patients with intermediate thickness melanoma (0.76 to 3.99 mm.) For melanomas ranging from 0.76 to 1.5 mm in thickness, the benefit of node dissection was primarily in male patients. Survival rates for melanoma at the two institutions were not significantly different in the multifactorial analysis, even after adjusting for all other variable. Thus, the biologic behavior of melanoma in these two different parts of the world was virtually the same, with only minor differences that did not significantly influence survival rates. Long-term follow-up exceeding eight to ten years after surgery is critical in the interpretation of these prognostic factors and the surgical results.

Adult↗
PubMed1982

Ulceration and prognosis in cutaneous malignant melanoma.

A review of 1818 patients with cutaneous malignant melanoma revealed that for both patients with localized disease (clinical stage I) and those with regional lymph node metastases at first presentation (clinical stage II), ulceration of the primary lesion was a poor prognostic sign. Although ulcerated lesions tended to be considerably thicker than non-ulcerated lesions, this factor did not entirely explain the poor prognosis recorded for patients with ulcerated lesions. In men and women matched by the thickness of their tumours, prognosis for those with ulcerated lesions was worse than for those with non-ulcerated lesions. This effect was particularly marked in women. It was concluded that since this histological feature was an independent prognostic determinant, it should be reported by the pathologist as a guide to the clinician in assessing prognosis in patients with melanoma.

Female↗
PubMed1981

Cutaneous malignant melanoma: occupational and prognosis.

In Queensland and New South Wales, malignant melanoma is being diagnosed and treated at an earlier biological stage than in previous years. An analysis of 670 men treated since 1973 at Sydney Hospital indicated that recognition of and survival from melanoma varied according to occupation. Unskilled patients had a markedly worse prognosis than more skilled patients, a finding attributable, at least in part, to later presentation for treatment. We conclude that although public awareness of melanoma has increased due to continual publicity, the educational programme must be concentrated on the lower socioeconomic groups.

Australia↗
PubMed1980

Malignant melanoma: influence of site of lesion and age of patient in the female superiority in survival.

Efforts were made to further explain female superiority in survival of 753 patients with clinical Stage I malignant melanoma. Two factors contributing to this female superiority in survival drew some of their prognostic value from the correlation with tumor thickness. (1) More than twice as many women as men had primary lesions located on the extremities, which were prognostically favorable anatomical sites in both men and women. In addition, women with extremity lesions had a more favorable prognosis than men with extremity lesions. This sex differential in survival for patients with extremity lesions was partly attributable to the fact that the extremity lesions of women were significantly thinner than those of men. (2) Significantly more women than men were under age 50; this age group of women had a significantly better prognosis than the corresponding age group of men. The sex differential in survival for patients under 50 years was partly attributable to the fact that the women's lesions were significantly thinner than those of men. There was only a slight sex differential in the survival of patients 50 years and over, a finding in consonance with the smaller difference in tumor thickness between these older men and women. The association between decline in prognosis with increasing age and decline in proportion of thin lesions with increasing age was much closer in men than women. In men and women matched by age, site, and thickness of primary lesions, women with very thick tumors still survived longer.

Adolescent↗
PubMed1980

Histologic features of tumors and the female superiority in survival from malignant melanoma.

The primary tumors of 780 patients with clinical Stage I malignant melanoma were reviewed to seek reasons for the female superiority in survival. Histologic features of tumors believed to be of prognostic significance were examined: tumor thickness, evidence of regression, histogenetic type, and mitotic activity. The average tumor thickness was significantly less in women, due to a preponderance of very thin lesions in women and very thick lesions in men. In both men and women, there proved to be a direct correlation between five-year survival rate and tumor thickness, but women had a higher survival rate than men at each thickness level. These latter two findings, in combination, could contribute to the overall female superiority in survival. No further insight into the sex difference in survival was obtained from the examination of the other histologic features. Although the incidence of partial lesion regression was not markedly different except for very thin lesions. There were no disparities between the sexes in the incidences of histogenetic types or grades of mitotic activity, two histologic features which drew their prognostic significance only from their correlation with tumor thickness.

Female↗
PubMed1980

Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I).

A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence. We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastases, it may be possible to prolong survival time.

Humans↗
PubMed1980

Is malignant melanoma arising in a Hutchinson's melanotic freckle a separate disease entity?

Several features which distinguish malignant melanoma arising in a Hutchinson's melanotic freckle (HMFM) from other types of malignant melanoma (MM) are described. Forty-eight patients with HMFM of the head and neck region were compared with 98 patients with MM of the head and neck region. All patients were clinical stage I. There was a preponderance of women amongst HMFM patients but not MM patients and HMFM patients were significantly older than MM patients. Although HMFM patients had thicker tumours than MM patients, these thicker lesions had a lower degree of mitotic activity and a higher incidence of partial regression. Overall prognosis for HMFM patients was significantly better than for MM patients, this being particularly so for women, none of whom died of melanoma. There was no close correlation between prognosis of HMFM patients and the thickness of their tumours. Every one of the HMFM in this study displayed evidence of severe solar degeneration, but such degeneration per se did not appear to confer upon these lesions their benign biological behaviour.

Age Factors↗
PubMed1979

Effect of smoking on the recurrence of malignant melanoma.

Smoking has been recently shown to lead to aberrant immunological function in man. Since immunological host resistance is important in the natural history of human malignant melanoma, it was the object of this study to determine the effects of smoking on the course of this disease. Investigations on 1908 patients with malignant melanoma indicated that smoking renders men significantly more susceptible to developing metastases. The proportion of men smokers free of disease five years after melanoma diagnosis was significantly lower than that of men non-smokers. An effect of smoking similar to that recorded in men was not evident in women with malignant melanoma.

Adult↗