Search PubMed⌕ Search

Biomedical subjects

M N Harris

Publications and source records attributed to M N Harris.

At least 91 records · Page 5Linked to original sources
PubMed1981

Factors related to thickness of melanoma. Multifactorial analysis off variables correlated with thickness of superficial spreading malignant melanoma in man.

Computer analyses to identify correlations between thickness of primary superficial spreading malignant melanoma and eighteen variables previously reported to be related to prognosis were performed on a series of malignant melanomas. The variables that showed statistically significant (less than or equal to 0.05) direct relationships to thickness were level (Clark), elevation of lesion, age of patient, least and greatest diameters of lesion, history of bleeding, ulceration, clinical and histologic stage, anatomic location, pedunculation, and satellitosis. The variables that did not correlate with thickness were clinical diagnosis of regional lymphadenopathy, in-transit metastasis, duration of lesion, sex, history of a previous malignant melanoma, and history of a pre-existing lesion at the site of the development of melanoma. Multiple regression analysis of the factors that showed statistically significant correlation with thickness of the primary lesion revealed a subset of six dominant variables that were most predictive of thickness, namely, level, elevation, largest diameter of lesion, ulceration, histologic stage, and age of the patient.

Female↗
PubMed1981

A prognostic model for clinical stage I melanoma of the lower extremity. Location on foot as independent risk factor for recurrent disease.

Thirteen variables were studied to determine their usefulness in predicting recurrent disease in 158 patients with stage I melanoma of the lower extremity. A Cox proportional hazards analysis demonstrated that three variables were independent risk factors for recurrent disease in these patients: (1) thickness, in millimeters, of the primary tumor (P = 0.000009), (2) primary tumor location on the foot (P = 0.0003), and (3) the number of mitoses/mm2 (P = 0.0244). Life-table analyses of patient subgroups defined by different combinations of these three variables demonstrated that thick (greater than or equal to 3.0 mm) melanomas of the foot were associated with recurrent disease much more frequently than tumors of similar thickness located on the thigh or calf. These data provide guidelines that can be used to evaluate results of surgical and/or adjuvant therapy studies for patients with melanoma of the lower extremity.

Foot Diseases↗
PubMed1981

Regional lymph node dissection for malignant melanoma of the extremities.

Seven hundred thirty-nine patients with malignant melanoma of the extremities were treated with a uniform surgical approach that included wide and deep excision of the primary site and regional node dissection therapeutically and electively for invasive lesions (Clark's levels III, IV, and V). Of the 490 patients who underwent lymph node dissections, follow-up was available for 457 (93%). Life-table comparison of 362 patients with histologically negative nodes to 95 with histologically proved lymph node metastases yielded statistically significant differences in survival (P less than 0.001). Five-year cumulative survival rates were 91% in the group without and 48% in the group with nodal metastases. Among histologically positive patients, differences in life-table survival curves for the 60 clinically negative patients compared to the 35 clinically positive patients were also statistically significant (P = 0.004); 5-year cumulative survival rates were 57% for the former group and 33% for the latter. Although there appears to be an advantage to regional lymph node dissection for micrometastases as opposed to gross nodal involvement, for the majority of patients metastatic melanoma in these nodes is the major indicator of systemic disease.

Actuarial Analysis↗
PubMed1980

Selective surgical management of cutaneous melanoma of the head and neck.

A series of 206 patients with cutaneous melanoma of the head and neck has been studied. Ninety patients had a regional lymph node dissections performed. Seventeen lymph node dissections were done therapeutically and 73 were done electively. Thirty-one patients had histologically positive lymph nodes and, of these, 30 patients have been followed to the present time or death. Twenty-nine of these patients (97%) have developed systemic melanoma. Twenty-six patients have died and three are alive with disease. No patient had local recurrence alone while four had local recurrence synchronously with systemic metastases. This contrasts with 29 patients followed for greater than five years with histologically negative nodes, 27 (93.1%) of whom are alive with no evidence of recurrent disease. Regional node metastases with melanoma of the head and neck is an almost certain indication of systemic disease. A selective surgical approach to invasive melanoma in this region is proposed based on the observation in the 31 patients who had radical neck dissections with histologically positive nodes. The metastases always involved the nodal group adjacent to the primary site. This selective approach should allow optimal local control and accurate pathologic staging while limiting the extent of the surgery.

Head and Neck Neoplasms↗
PubMed1980

Biopsy for microcalcification detected by mammography.

Fifty-two patients who were biopsied because of the presence of clustered microcalcifications on mammography, in the absence of any definable mass on x-ray or physical examination, were studied. Localization of the microcalcifications was obtained by measuring the area in relation to the vertical and horizontal axes from the nipple on both lateral and cephalocaudad views. Specimen radiography was obtained to ensure that the area with microcalcifications had been included in the specimen. Carcinoma was found in 17 instances (33%). In four (24%) the detected microcalcifications corresponded to fibrocystic disease, with carcinoma being found only in adjacent tissue with little or no calcifications. Precise localization and removal of only the area containing calcifications without excision of a generous margin of surrounding tissue may result in the exclusion of an adjacent carcinoma.

Adult↗
PubMed1979

Malignant melanoma. Delayed hypersensitivity skin testing.

One hundred eighty-two patients undergoing initial surgical therapy for primary malignant melanoma were evaluated for delayed hypersensitivity using a battery of recall antigens prior to surgery. Fifty-six patients were also sensitized with 2, 4-dinitrochlorobenzene. All tumors were classified by Clark-Mihm levels and the patients were clinically staged. They were followed up for an average period of 55 months. There was no significant difference in the ability of patients with varied Clark-Mihm level lesions to mount a delayed hypersensitivity response to the recall battery or to 2, 4-dinitrochlorobenzene. Thirteen stage I melanoma patients in whom recurrence developed at a distant site exhibited no difference in immune responsiveness when compared to 148 patients in whom recurrence did not develop when both groups were tested with recall antigens. No difference was noted in patients with stage II disease in whom recurrence developed, as measured by reaction to these same antigens. Twelve patients demonstrated anergy to recall antigens, in none of whom has recurrence developed to date. Fifty-six patients who were tested with 2, 4-dinitrochlorobenzene showed no difference in reactivity with tumors classified at any of the Clark-Mihm levels. Anergy demonstrated by delayed hypersensitivity skin testing appears to reflect increasing tumor burden, rather than a preexisting deficiency that can be used to predict patients at high risk for the development of recurrent disease.

Adult↗
PubMed1979

Cutaneous melanoma of the breast.

A series of 21 patients treated surgically for primary melanoma of the skin of the breast has been studied. Melanomas in this location accounted for 1.8% of a total of 1,140 patients with primary clinical Stage I and Stage II melanomas treated during a 28 year period. Wide excision with axillary lymph node dissection in selected instances has resulted in no mortality and no local recurrence to date. This approach allowed the preservation of a major portion of the breast in eight female patients. It is emphasized that melanoma is a cutaneous lesion and considerations applying to lymphatic dissemination of parenchymal disease of the breast need not apply.

Adult↗
PubMed1979

Assessment of biopsy techniques and histopathologic interpretations of primary cutaneous malignant melanoma.

The biopsy techniques utilized for diagnosis in 1,161 patients with primary cutaneous malignant melanoma treated at the New York University Medical Center were reviewed. Eight hundred sixty-four (74%) biopsies were of the excisional type and 269 (23%) were incisional. Twenty-eight biopsies (3%) could not be assessed. Two hundred fifty-two consecutive patients referred for treatment of malignant melanoma to the authors for the last three years were studied to determine whether standard techniques of biopsy and uniform criteria for histopathologic diagnosis and staging were being utilized. One hundred forty-nine of these patients (59%) had total excisional biopsies of their lesions and 103 (41%) had incisional biopsies. Of the latter group, 66 (64%) were for lesions less than 2 cm in diameter and were situated in areas other than the face. The biopsy specimens obtained from 123 patients were reviewed by at least one other pathologist as well as our own (A.B.A.). For these 123 patients a difference of histologic diagnosis between pathologists occurred in 11 (9%). In 58 (47%) there was a discrepancy in assignment of Clark levels or a failure to assess Clark levels. Tumor thicknesses as measured by Breslow were read in only 22 (18%) of these 123 patients. The inadequacies of many of the biopsy specimens and discrepancies in histopathologic interpretation indicate that acceptable biopsy techniques and reproducible diagnostic criteria have not yet been generally adapted for primary cutaneous malignant melanomas.

Biopsy↗
PubMed1977

Total mastectomy with axillary dissection. A modified radical mastectomy.

A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation.

Axilla↗
PubMed1976

Present status of surgical management of malignant melanoma.

Malignant melanoma has a distinctive appearance and has been clinically and histologically classified by Clark and Mihm. Using this classification a rationale for the surgical treatment of melanoma has been developed at the New York University Medical Center. The choice and extent of surgery is described. Early detection of melanoma and prompt surgical attention can significantly reduce the mortality from this neoplasm.

Humans↗
PubMed1975

Melanoma of the head and neck.

A series of 94 patients with cutaneous malignant melanoma of the head and neck region has been studied. Fifty-three of the patients had regional lymph node dissections performed and the results in 37 performed more than 5 years ago are presented. The policy of elective lymph node dissection for invasive melanoma of the head and neck is strongly endorsed, although not proven by the data presented in this limited series. Whenever possible, a total excisional biopsy should be performed to establish the diagnosis. It is recommended that all melanomas be classified by the method of Clark and Mihm and that the level of invasion also be determined. There is an appreciable error in the clinical evaluation of lymph nodes for metastases. In general, it is suggested that elective regional lymph node dissections be performed for invasive melanoma (levels III, IV and V). The literature pertaining to cutaneous melanoma of the head and neck has been reviewed and surgical and pathological problems peculiar to lesions of this region are emphasized.

Follow-Up Studies↗