James C. Briggs

Extrapulmonary oat cell carcinoma

Primary extrapulmonary tumors with histologic features indistinguishable from bronchogenic oat cell carcinoma are appearing with increasing frequency in the literature. These tumors have been described in the esophagus, stomach, pancreas, larynx, hypopharynx, salivary glands, nasal cavity and paranasal sinuses, thymus, small and large bowel, uterine cervix, endometrium, breast, prostate, urinary bladder, and skin. It is now widely believed that oat cell carcinoma is a poorly differentiated counterpart of carcinoid tumor and that both originate from an endocrine cell system. In this article, the authors review all cases of extrapulmonary oat cell carcinomas, which they were able to find in the English literature, and report personally studied examples of these tumors, occurring in the esophagus, stomach and urinary bladder. A closely related, if not identical, tumor arising in the skin is also described. It is emphasized that a wider recognition of these tumors is likely to lead to their more frequent diagnosis and possible treatment.

Subungual melanoma: a clinico-pathological study of 24 cases

Twenty-four patients with subungual melanoma (13 women and 11 men) had a mean age of 61.6 years. Twenty-two lesions arose either on the thumb or hallux. The mean delay before diagnosis was 30 months. Two patients presented with stage two melanoma and three of the melanomas were in situ lesions (Clark level 1). Nineteen melanomas were Clark level 4 or 5 and the mean thickness of the invasive melanomas was 4.7 mm. Seven patients died of metastatic disease (mean survival 10 months, range 6-50 months). Clark level, thickness and mitotic activity of the melanomas correlated with poor clinical outcome. Delay in presentation and the presence of advanced disease contribute to the poor prognosis of this tumour.

The incidence of late recurrence (greater than 10 years); an analysis of 536 consecutive cases of cutaneous melanoma.

The main purpose of this study was, using a computerised database, to try to establish possible prognostic features shown in patients who develop late recurrence, after 10 years, from a melanoma. The records of 536 patients diagnosed and treated for cutaneous melanoma over a 10-year period were examined and 5 patients were found to have developed a late recurrence. These patients were all female and included both pre- and post-menopausal cases at the time of initial diagnosis. In 4 out of the 5 cases the primary lesion had been situated upon an extremity. This study adds to the evidence that prognostic indicators can lead to a possible identification of high risk patients and that the level of patient awareness and education must be maintained throughout the period of follow-up.

Malignant melanoma and squamous cell carcinoma in a burn scar.

Abstract The rare combination of contiguous squamous cell carcinoma and malignant melanoma arising synchronously in a burn scar is described.

Experience of thin cutaneous melanomas (< 0.76 mm and < 0.85 mm thick) in a large plastic surgery unit: a 5 to 17 year follow-up

The detailed histological findings of 728 melanoma patients treated at Frenchay Hospital during the period 1967 to 1978 have been fully reviewed and analysed. Of these, 75 patients with lesions less than 0.76 mm thick and 15 with lesions greater than 0.75 mm and less than 0.85 mm thick have been identified using a computerised data base. The general practitioners of all the patients in the series have been approached and the clinical histories found in nearly every case (69/75 and 15/15) thus providing a follow-up period of 5 to 17 years. A number of fatal melanomata have been found in these two groups. The histopathological features have been related to the known prognosis in an attempt to characterise the lethal lesions. No statistically significant relationship could be found between prognosis and any histological feature, including specifically the amount of regression within the lesion. However, it was found that assessment of the ratio of the uninvolved dermis beneath the tumour to tumour thickness itself might prove helpful in future case evaluation.

Desmoplastic melanoma: a clinico-pathological review

Desmoplastic Melanoma (DM) represents a rare histological variant of melanoma. It has been described in isolated case reports as a cutaneous tumour with a high incidence of local recurrence and nodal metastases, requiring early aggressive surgery. However, overall clinical experience of the tumour is limited. 13 patients with DMM seen over a 20 year period were reviewed. The mean age at presentation was 67 years (range 34-87), and 2/3 of the lesions were in the head and neck. Tumour thickness averaged 5.78 mm (Breslow). 7 patients developed recurrence, 4 as regional nodes, and 3 as skin nodules. Four of these patients developed disseminated disease, of whom 3 died. The mean time to first recurrence was 26 months and mean follow-up time in the review was 40 months (range 3-141 months).

Subungual malignant melanoma: a review article.

Abstract It is the policy of the Editorial Committee, from time to time, to invite specialist review articles by experts in their own fields. This is such a paper and we are grateful to Dr James Briggs for this contribution.

Recurrence of thin melanoma: how effective is follow-up?

In order to assess the benefit to patients with thin malignant melanoma (< 0.76 mm) of a 5-year clinical follow-up programme, we have studied 602 patients with a minimum time from primary surgery of 5 years. Tumour recurrence occurred in 24 patients (4% of all patients) but only five surgically treatable recurrences (< 1% of all patients) occurred within the 5-year period following primary surgery. After 5 years there were four surgically treatable recurrences, but their prognosis was generally poor. The remaining cases of tumour recurrence were not surgically treatable. In the face of an increasing incidence of melanoma, and the accompanying increase in demand for surgical treatment and outpatient review, we question the need for prolonged hospital follow-up of thin melanoma.

Are malignant melanoma time trends explained by changes in histopathological criteria for classifying pigmented skin lesions

The incidence of malignant melanoma in developed countries has been rising rapidly in recent years. Its causes and the reasons for this trend are uncertain. Changes in histopathological criteria for classifying pigmented skin lesions could explain the rising incidence rates. With support from the International Agency for Research on Cancer, this hypothesis is explored but not substantiated for time trends in the South Western Region, United Kingdom.

Malignant melanoma, evaluation of clinical follow up by questionnaire survey

Abstract A retrospective questionnaire study, by post, revealed that 69% of patients, still living following first tumour recurrence, had detected the recurrence themselves prior to routine clinic appointments. Nearly 90% developed their first recurrence in the first 5 years following primary surgical treatment. Not only could the length of routine clinic follow-up after primary melanoma treatment be shortened, but with further education of the patient and involvement of the general practitioner it seems likely that patients can be trusted to detect their own recurrences and seek appropriate advice.