Neville C. Davis

Malignant melanoma in Queensland: a study of 219 deaths.

A series of 219 patients who died within five years of histological diagnosis of their melanoma is reported. One hundred and fifty‐eight died of melanoma and in three melanoma contributed to death. Male to female ratio was about 2:1 There was a progressive increase of deaths in each cohort in males with aging, but in females only after 60 years of age. Fatal melanomas arose most commonly on the back. Face and thigh lesions were responsible for an approximately equal number of deaths and thigh lesions were shown to have a worse outlook than melanoma of the leg. This series contained a large proportion of patients with melanomas bigger than 2 cm. and of the 13 patients with lesions larger than 3 cm., 10 had metastases on registration with the Queensland Melanoma Project. The presence of only three flat melanomas would indicate a generally better outlook for this type of lesion. Ulceration and bleeding suggested a poor prognosis. The large number of patients (78) who had microscopic evidence of metastases on registration contributed to the poor survival in this series. Of the 78, 30 patients presented with metastatic disease and no primary melanoma was found. The findings from 29 autopsies indicated the ability of melanoma to disseminate widely. Fifty‐one patients died from causes other than melanoma, the more common being cardio‐vascular and cerebro‐vascular disease.

Historical overview of melanoma

Abstract This consideration of the development of knowledge about malignant melanoma is confined to the period from the late 18th to the early 20th century. It was in this period that the first descriptions of melanoma as a disease entity were published, and the foundation of the principles of management was established.

MALIGNANT MELANOMA IN QUEENSLAND A REVIEW

A study into malignant melanoma in Queensland commenced in 1963 and the findings are reviewed and the attitudes to management explained. The incidence of the disease is higher in Queensland than anywhere else in the world. This probably results from the long continued exposure of a susceptible white population to sunlight.

MALIGNANT MELANOMA IN QUEENSLAND1

Between July 1963 and December 1968, all cases of proven malignant melanoma occurring in Queensland were registered at the Research Unit of the Princess Alexandra Hospital as part of the Queensland Melanoma Project (Davis and Herron, 1966). During 1969, only selected teaching hospital cases were registered. In all, during the whole period, we have detailed records of 1,514 patients and these constitute the basis of this paper. In all cases, the microscopic diagnoses were reviewed by a panel of pathologists before the case was regarded as proven.

Early Post‐operative Intestinal Obstruction After Gynaecological Surgery

1 Always consider the possibility of mechanical obstruction in the early postoperative period, even though the symptomatology is atypical. Do not be misled into thinking it is a case of paralytic ileus just because pain is absent or insignificant. 2 Paralytic ileus does not recur. If there is recurrent vomiting or distension think of a mechanical cause. Check the serum electrolyte levels and give intravenous potassium if indicated. 3 Re‐examine the patient frequently and take particular note of the pulse. 4 Take repeated x‐rays of the abdomen, as they will often show whether the obstruction is progressing or not. Remember that oral Gastrografin will often reach the caecum in six hours if the bowel is not mechanically obstructed. 5 Strangulating obstruction is not uncommon, occurs particularly in the first week and carries a high mortality. 6 Use continuous suction in preference to intermittent suction because the former removes air as well as liquid. Do not imagine that suction decompression will be effective in all cases. 7 Remember the indications to re‐open the abdomen: