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Biomedical subjects

H M Shaw

Publications and source records attributed to H M Shaw.

At least 91 records · Page 5Linked to original sources
PubMed1979

Prognostic significance of the histological features of malignant melanoma.

A review of 694 patients with localized cutaneous malignant melanoma (clinical stage I) revealed that three histological features of the primary lesion had no effect of their own on survival rate but derived their prognostic significance only because of their close correlation with tumour thickness. Primary lesions of superficial spreading histogenetic type, or of low mitotic activity or showing evidence of partial regression appeared to have a more favourable prognosis than lesions of nodular histogenetic type or of high mitotic activity or showing no regression. However, the former three histological features were predominant in thin lesions which had a better prognosis than thicker lesions. It was concluded that these features exerted only an indirect effect upon survival, tumour thickness being the most important prognostic determinant.

Humans↗
PubMed1978

Laser surgery for malignant melanoma and superficial malignancies.

This study describes 18 months' experience with the CO2 laser in the treatment of malignant melanoma and other superficial malignancies. In 110 patients, a general assessment was made of the advantages commonly claimed for the laser. In addition, a comparison between laser and scalpel surgery was made by means of a small retrospective study. Results from 39 patients undergoing wide excision and graft for primary malignant melanoma in association with axillary lymph node dissection indicated that the laser offered no specific advantages over the scalpel for this particular type of operation. The laser was shown to have specific advantages in the treatment of extensive superficial malignancy, in locally recurrent tumours, and in malignancy of soft tissues. In these situations it did minimize blood loss and achieve satisfactory extirpation of the lesion.

Adolescent↗
PubMed1977

Changing trends in mortality from malignant melanoma.

Five-year survival rates for both men and women treated at the melanoma clinics at St Vincent's Hospital and Sydney Hospital and at Royal Prince Alfred Hospital were found to have gradually improved over a 26-year time period. It is concluded that the improved survival rates do not result from changes in the sex ratio of the patients presenting for treatment, their age or the site distribution of their primary lesion. It is suggested that a change in the biological nature of malignant melanoma may have occurred over this time period. Such a change, if proven, would cast doubt on the value of investigations in which historical controls are used to monitor the effects of changes in therapy.

Adult↗
PubMed1977

Occult primary malignant melanoma: factors influencing survival.

Seventy-six patients with occult primary malignant melanoma were studied in order to detect features which would help to determine prognosis. It was found that the 5-year survival rate of these patients was: (a) no worse than in patients first presenting with one known primary lesion and metastases; (b) just as poor for women as for men; (c) more favourable if only a single lymph node was involved with secondary deposits; (d) similar whether the manner of spread of the disease was lymphatic or haematogenous; (e) similar whether there was or was not a history of a pre-existing lesion. The prognosis for occult primary malignant melanoma, although bad, is not hopeless.

Adult↗
PubMed1976

Multiple primary cancers in patients with malignant melanoma.

The incidence of second primary tumours not related to the skin in patients with malignant melanoma was determined. This was compared with the corresponding incidence of a first primary tumour in the general age-matched population. The available data indicate that, in patients with malignant melanoma, there exists a predisposition to developing a second unrelated cancer.

Adult↗
PubMedDate not supplied

Rare variants of malignant melanoma.

The personal experience with 5 rare types of malignant melanoma is reviewed to point out some of the practical problems in the diagnosis and management of these tumors. The rare forms discussed are conjunctival, nasal, oral, vulvar, and penile melanomas. All pigmented lesions in the oral cavity, but not the penis or vulva, should be prophylactically excised as lesions in the mouth have a higher malignant potential. Local excision of all 5 forms of primary melanomas, no matter how locally advanced they may be, is the sole treatment. Nevertheless, anatomic constraints often preclude surgery with generous margins and consequently local recurrence, particularly for conjunctival, nasal, and oral primary lesions, is usually the major first failure in treatment. Lymph node dissection is only performed if the regional nodes are palpable at the time of first presentation. Elective lymph node dissections are not performed since the patients are often elderly, the lymphatic drainage is usually ambiguous or multiple, and the disease tends to spread hematogenously rather than lymphatically. Surgery still remains the cornerstone of treatment for these rare forms of melanoma but prognosis is very poor since surgery is often a palliative rather than a curative measure. Improved survival may depend on identifying more effective chemotherapeutic and immunologic agents.

Adult↗
PubMedDate not supplied

Malignant melanoma in childhood: a clinicopathologic study of 13 cases and comparison with Spitz nevi.

The clinical and histological features of 13 malignant melanomas in children less than 13 years of age in New South Wales, Australia, were compared with those in a control group of children with 15 Spitz nevi, 4 of which were considered atypical, and 2 unusual compound nevocellular nevi. Six of the controls had been previously diagnosed histologically as malignant melanoma. The objective observations made by one or more histopathologists experienced in reporting melanocytic lesions, and the clinical details, mainly from the Sydney Melanoma Unit files, were entered on a detailed protocol. Evaluation was assisted by the use of SPSS-X software on a mainframe VAX computer. Six of the 13 children with malignant melanoma died with their disease. The most frequent clinical features found in the malignant melanomas were bleeding, ulceration, itching, and black or variegated color. Recent enlargement and darkening were noted in the majority of both the malignant melanomas and the Spitz nevi. Histological features favoring malignancy in this series were mitoses within 0.25 mm of the dermal margin of the melanoma, a dermal mitotic rate exceeding 2/mm2, ulceration, surface exudate, large pigment granules, and clear-cell differentiation. The median thickness of the malignant melanomas was 1.3 mm but in the 4 children who died with melanoma the median thickness was 2.9 mm. Absence of mitoses, predominance of spindle cells, and diffuse maturation favored Spitz nevus. The median thickness of the Spitz nevi was 0.7 mm.

Adolescent↗
PubMedDate not supplied

Predicting survival and recurrence in localized melanoma: a multivariate approach.

Several clinical and pathologic factors appear to affect melanoma recurrence and survival. While much attention has been directed at identifying prognostic factors, few researchers have developed predictive models for survival and recurrence. Two major clinical questions are of interest in the management of melanoma: 1) what is the patient's chance of surviving for a given period, e.g., 5 or 10 years, after diagnosis of melanoma; and 2) after a patient has been disease free for a period of time, e.g., 5 years, what is his or her chance of melanoma recurrence or death in the following interval, e.g., 5 years or 10 years. In this paper, a generalized multivariate prognostic model to address both of these clinical questions is presented. Tables of the estimated probabilities of melanoma recurrence and death for prognostic subgroups are shown to facilitate prediction of an individual patient's outcome. The model was based on a database of 4,568 patients with localized melanoma, one of the largest melanoma databases in the world with detailed clinical and pathologic information, and long-term follow-up. Tumor thickness at diagnosis was the single most important prognostic factor for all outcomes. Tumor ulceration, Clark's level, lesion location, and sex had an impact on overall survival from diagnosis for some of the subgroups defined by tumor thickness. Tumor thickness at diagnosis was strongly indicative of melanoma recurrence and death even after a disease free interval of 2, 5, or 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Alabama↗