Danely P. Slaughter

Malignant melanomas of the skin of the head and neck

Abstract 1. 1. Fifty-eight patients with malignant melanoma of the head and neck are presented; thirty-eight patients formed the definitive group. 2. 2. Over-all survival five years free of disease was 39.5 per cent. 3. 3. The salvage was not significantly different whether the treatment was (a) adequate local excision generally accompanied by skin graft, (b) adequate excision and elective regional node dissection, or (c) therapeutic node dissection when the primary tumor was controlled. 4. 4. No patient survived who had a recurrent primary tumor and clinical evidence of regional node disease. 5. 5. Heroic surgery for primary or metastatic disease was unsuccessful both as to salvage or significant palliation. 6. 6. Primary treatment suggested is adequate local excision if the neck is clinically negative. 7. 7. Elective neck dissections are reserved for patients in whom such dissection can be performed in valid continuity or when the primary tumor is recurrent.

Prophylactic measures in the spread of carcinoma of the colon and rectum.

ANY mSCUSStON of prophylactic measures in the prevention of spread of carcinoma should be preceded by a brief statement of the mechanisms of spread of the disease. There are four major mechanisms concerned in this spread. They may be summarized as follows: 1. by lymphatics, 2. by contiguity through tissue planes, 3. by implantation, and 4. by vascular channels. Efforts to prevent spread must be directed towards these various mechanisms of dissemination. The first two have been discussed in detail in the medical literature,a, is, 39 Samson Hanley was the pioneer in the study of spread by lymphatics. The medical profession has been aware of the spread by implantation and venous emboli, but in our opinion too little attention has been paid to these mechanisms by the surgeon.

PANEL DISCUSSION ON THE PALLIATION OF ADVANCED CANCER IN THE OLDER AGE GROUPS

MODERATOR SLAUGHTER: Cancer is by no means confined to older age groupsThe majority of cases occur in elderly people. If we could utilize known methods of cancer treatment to the best of our ability, the cure rate might approach 50 to 75 per cent. In actual practice, probably less than 25 per cent of cancer patients, excluding those with carcinoma of the skin and lip, are cured by modern methods of treatment. That figure points up the statistical enormity of the problem of patients who are not cured but who seek palliation. It is the concern of physicians to do everything possible for these patients and not to ignore them. Among several means of treatment are palliative surgery, which is important in relation to the cancer problem, and palliative irradiation. Perhaps even more important for the future are newer approaches, such as endocrine modification and chemotherapy. These means are being used more and more. I hope that they will become increasingly useful in the management of cancer. Cancer affects every tissue in the body. Almost every medical specialty is involved. Therefore, deliberately included in this panel were a general surgeon, a gynecologist with extensive experience in radiation therapy of the pelvic organs, an internist-endocrinologist, and a radiologist. I should like to hear from each of them.