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Biomedical subjects

R J Friedman

Publications and source records attributed to R J Friedman.

At least 145 records · Page 8Linked to original sources
PubMed1985

Congenital-nevus-like nevi, nevi spili, and café-au-lait spots in patients with malignant melanoma.

The prevalence of congenital-nevus-like nevi (CNLN) in a group of 105 adults who had malignant melanoma (MM) was compared with that in a control group of 601 adults not afflicted by MM. Total cutaneous examinations were performed on both groups. The control group presented with complaints other than pigmented lesions. In this series, 10 (9.5%) of the group with MM had clinically diagnosed CNLN 1.5 cm or larger in diameter. These CNLN were not in contiguity with the MM sites. The 9.5% prevalence of CNLN in the group with MM was significantly higher (p less than 0.005) than the 2.5% CNLN observed in the control population. None of the patients in either group had large congenital nevocytic nevi (greater than or equal to 20 cm). In addition, in the group with MM, 5 patients (4.8%) had nevi spili (NS) and 13 (12.4%) had café-au-lait spots (CLS). The prevalence rates for these two types of pigmented lesions were not significantly different from those observed in the nonmelanoma control group (2.3% for NS; 13.8% for CLS). The relative risk for developing MM is 4.1 in people with CNLN compared with those without CNLN, which indicates that these nevi may be markers for individuals prone to develop malignant melanoma.

Adult↗
PubMed1985

The dysplastic nevus. Clinical and pathologic features.

The dysplastic nevus has not only been considered to be a "marker," but also a formal "precursor" of malignant melanoma. Therefore, these lesions are important to recognize clinically. This article presents a classification of the dysplastic nevus based upon its variable clinical presentations. It is hoped that this classification will assist the physician to recognize many of the clinical variants of this unusual melanocytic nevus and, thus, to identify patients at greater risk for the development of malignant melanoma.

Biopsy↗
PubMed1985

The management of patients with dysplastic and congenital nevi.

Although both dysplastic and congenital nevi appear to have a greater-than-expected risk for evolving into malignant melanoma, the magnitude of that risk is uncertain. For this reason, the management of patients with these lesions remains controversial. The National Institutes of Health Consensus Conference guidelines are presented with specific recommendations for the management of patients.

Humans↗
PubMed1985

The clinical features of malignant melanoma.

The clinical diagnosis of malignant melanoma requires the following: an acceptance of the concept of "in situ" malignancy, both clinically and histologically; a high index of suspicion concerning any pigmented lesion; recalling the mnemonic "remember your A,B,C,D's"; and a knowledge of the clinical simulators of malignant melanoma. Prevention of death from malignant melanoma is possible through early diagnosis and prompt treatment of thin lesions (less than 0.76 mm in thickness). Such lesions have an excellent prognosis. This goal can be reached by carefully designed and implemented professional and public education programs such as those that have been introduced in Australia, West Germany, and the United States. Currently, new programs are being developed jointly by the American Academy of Dermatology and the American Cancer Society that are aimed at promoting self-examination of the skin as an adjunct to a routine physician examination as an additional means of detecting malignant melanoma at a time when it is wholly curable.

Basal Cell Carcinoma↗
PubMed1985

Prognosis of malignant melanoma.

Multiple factors appear to influence survival in patients with malignant melanoma. Although at present thickness appears to be the best individual prognostic factor, other variables such as anatomic site of the lesion, ulceration, and level consistently appear in multivariate prognostic models. These multivariate models enable the assessment of patient prognosis for the optimization of treatment as well as the evaluation of future therapeutic trials. Future study of these prognostic factors will hopefully help us to understand the pathophysiology of melanoma and, possibly, unlock the secrets of the biology of this disease.

Age Factors↗
PubMed1985

Precursors of malignant melanoma. Problems in computing the risk of malignant melanoma arising in dysplastic and congenital nevocytic nevi.

It has recently been shown that both dysplastic and congenital nevi are precursors to malignant melanoma. These findings are based upon mathematical models that show an increased risk of the nevi evolving into melanoma over random choice. However, problems exist with these models that may invalidate their results. The recommendation to remove dysplastic and congenital nevi prophylactically based upon models such as these is premature.

Humans↗
PubMed1985

Prevalence of congenital-nevus-like nevi, nevi spili, and café au lait spots.

To determine the clinical prevalence of medium-sized (1.5- to 19.9-cm-diameter) congenital-nevus-like nevi (CNLN), a consecutive series of 601 patients (mostly adults) had total cutaneous examinations. In this series, 15 (2.5%) were found to have such lesions. In addition, 14 (2.3%) had nevi spili and 83 (13.8%) had café au lait spots. All three types of lesions were equally represented in both sexes and tended to spare the head, neck, and upper extremities. Compared with CNLN, nevi spili were found to have significantly larger diameters and lower mean age, suggesting that these are different types of lesions. Some recommend the surgical removal of all congenital nevocytic nevi because of their malignant potential. Since it is not possible to clinically distinguish congenital nevocytic nevi and CNLN and since the observed prevalence of these lesions in adults is over four times that previously reported in newborns, such a recommendation becomes less feasible.

Adolescent↗
PubMed1984

"Microscopic satellites" are more highly associated with regional lymph node metastases than is primary melanoma thickness.

A multivariate analysis was performed on 20 clinical and histologic variables from 327 Stage I prospectively studied melanoma patients who underwent elective regional lymph node dissection (ERLD). Primary tumor thickness, microscopic satellites, and the elapsed interval between diagnosis and ERLD, were selected as the combination of variables that were most highly associated with clinically occult regional lymph node metastases (P = 10(-15), model chi-square). Microscopic satellites were defined as tumor nests, greater than 0.05 mm in diameter, in the reticular dermis, panniculus, or vessels beneath the principal invasive tumor mass but separated from it by normal tissue on the section in which the Breslow measurement was taken. The probability of finding nodal metastases for melanomas less than 0.75 mm thick was 0% (0/41 patients); for those 0.76-1.50 mm, 4% (4/108); 1.51-3.0 mm, 14% (14/102); and greater than 3.0 mm, 39.5% (30/76). Primary melanomas greater than 1.50 mm thick with microscopic satellites were more often associated with nodal metastases than those of similar thickness without satellites (30/57 (53%) versus 14/121 (12%), P = 0.01). Some satellites probably represent intraspecimen metastases, while others do not. Any predictive model for occult regional lymph node metastases based on data from ERLD done less than 50 days after diagnosis may underestimate the prevalence of metastases.

Adult↗
PubMed1984

Malignant melanoma in World War II veterans.

In a consecutive series of 1,067 patients entered into the data base of the Melanoma Cooperative Group at New York University School of Medicine between 1972 and 1980, 120 men were of draft age (18-31 years) during World War II (1941-1945). Questionnaires were sent to these 120 individuals; 89 responded. Simultaneously, a control (nonmelanoma) population of 65 men of similar age was queried. Each subject in both groups was asked whether he had served in the armed forces during World War II and, if so, what were his theaters of operation. Based on the response, 83% (74 of 89) of the melanoma group compared with 76% (49 of 65) of the control group had served in the armed forces during World War II; however, a significantly (p = 0.0002) greater percent of the melanoma patients (34%) served in the tropics than did the control subjects (6%). Further, overrepresented in the melanoma group that served in the tropics (compared with the melanoma group who served in the armed forces in nontropical theaters) were malignant melanomas that had their origin in nevocytic nevi. The findings suggest that Caucasian individuals heavily exposed to sunlight in the tropics for several years during early life may be at higher risk to the subsequent development of cutaneous malignant melanoma. In some individuals this may be a two-step phenomenon, in which the first step is the solar induction of nevocytic nevi and the second is malignant transformation within them.

Aged↗
PubMed1984

Vascular injuries and closed extremity fractures in children.

The association of a major vascular injury with a closed extremity fracture in the pediatric patient is uncommon. The present study of seven such patients includes five fractures treated by open reduction and internal fixation (ORIF) prior to vascular reconstruction. Two were treated in skeletal traction without vascular reconstruction. Most vascular injuries were not diagnosed initially, consequently delaying repair. Early follow-up examination revealed the following complications: wound infections, below-knee amputation, deep vein thrombosis (DVT), and motor and sensory deficits. All of the fractures healed. Late follow-up examinations revealed two cases of overgrowth and one of limb undergrowth. Minor motor and sensory deficits were present, but overall function was good. Arteriography should be performed prior to surgical repair. Because of problems with growth disturbance that require long-term follow-up evaluation, all major vascular injuries should be repaired despite adequate collateral circulation to keep the limb viable. Prompt, accurate diagnosis followed by surgical repair will improve the long-term results.

Accidents, Traffic↗
PubMed1984

Acquired spondylolisthesis following scoliosis surgery. A case report.

The association between scoliosis and spondylolisthesis is well documented; however, spondylolisthesis following a posterior spinal fusion with Harrington rod instrumentation for idiopathic scoliosis has not been previously reported. Internal fixation of the spine with metal rods and fusion for scoliosis produces a stress concentration at the immediately adjacent levels. This, combined with other factors that may cause failure of the neural arch, can lead to a traumatic spondylolisthesis. In an 11-year-old boy, localized pain and impending listhesis indicated that the instrumentation should be removed and an arthrodesis completed.

Child↗
PubMed1983

Metastases of thin melanomas.

Although thin malignant melanomas, i.e., those less than 0.76 mm in thickness, of the skin generally do not metastasize, it has been recently reported that when histologic regression is present, such lesions may then have a greater propensity for dissemination. However, this was not apparent in this study in which only one melanoma metastasized in a consecutive series of 41 thin lesions which were step-sectioned and had evidence of regression histologically. Possible explanations for this discrepancy are the failure of other authors to include only step-sectioned specimens of the primary melanomas in their material and/or geographic differences in the biologic behavior of this malignant neoplasm.

Adult↗
PubMed1983

Regression in malignant melanoma.

A multiple stepwise logistic regression analysis shows that histologic regression is more likely to be found in a malignant melanoma that is level III or less, more than 10 mm in diameter, associated with solar elastosis, located on an anatomic area other than the head or neck, and when there are areas of whiteness clinically. Although patients with malignant melanomas displaying signs of regression histologically have a slightly better 5-year disease-free survival, this may be attributed to a difference in tumor thickness.

Humans↗