Use of combination chemotherapy with CCNU, bleomycin, and vincristine in the treatment of metastatic melanoma in patients resistant to DTIC therapy.
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Biomedical subjects
Publications and source records attributed to J D Everall.
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Cancers of the skin are not properly registered and our lack of precise knowledge of the influence of environmental factors is due both to a failure to report and a failure to attribute because many tumours are not recognised as due to environmental factors and escape notification due to lack of knowledge and teaching. The long latent period also interferes. The commonest cancer is squamous cell carcinoma followed by basal cell carcinoma. Melanoma is exceedingly rarely environmental. The main causative agents are: Polycyclic aromatic hydrocarbons (PAH), inorganic arsenic and ionising radiation. PAH induce 4 times more cancer of the scrotum in workers using cutting oils or pitch than expected. These subjects have also increased incidence of second primaries of both the skin and internal organs. The latent period varies from 20 years (exposure to coal tar) to 50 years or more (exposure to mineral oils). Exposure to pitch may result in 11 fold increase incidence of squamous cell carcinoma. Skin cancer due to arsenic is rare. It has been seen in sheep dip workers, in patients treated with Fowler's solution and in vineyard workers using arsenical pesticides and drinking contaminated wine. The latent period may go up to 60 years. Ionising radiation over 1,000 rems may cause basal and squamous cell carcinoma. The latent period varies from 7 weeks to 56 years (average 25--30 yrs).
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The immunofluorescent patterns in the skin of eighteen patients with Besnier's prurigo were studied at different stages of eczematous lesions. The presence, distribution pattern, and numbers of immunoglobulin and complement-positive lymphocytes in twenty-nine biopsies are reported. In all cases IgE-positive lymphocytes were present in both clinically uninvolved and involved skin. IgG, IgM and IgE-positive lymphocytes showed a characteristic distribution pattern in the dermis. In the acute stages IgM deposition was prominent in the basement membrane zone and it is suggested that damage to the basement membrane results in diffusion of immunoglobulin and complement into the epidermis. These features were not present in a control group of normal skin and of other dermatoses.
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The results of treatment of two groups of patients with primary melanoma are compared. 25 patients in group 1 were treated by wide local excision of the primary melanoma, and 23 in group 2 were treated by vaccination with live vaccinia virus 14 days before wide local excision. Vaccination exerts a favourable effect on the course of melanoma both in terms of survival and prolongation of the interval between treatment of the primary lesion and subsequent development of metastases.
The case history of a patient who presented with erythema annulare centrifugum and white banding of the toe nails is recorded. On investigation for an underlying malignancy the patient was found to have an opacity in the lower lobe of the right lung. Subsequently lobectomy was performed and histology of the operative specimen revealed a malignant carcinoid tumour of the bronchus.