single institution 18-years retrospective analysis of malignant melanoma

Melanoma accounts for about 2% of all cancer-related mortality in western populations. Surgical excision of localized disease is curative in many patients with 80% overall 5-year survival rate. There are many indicators of prognosis of which tumor burden is predicted by primary site with nodal status being the next most important variable. Patients with advanced stage have very high risk of developing distant metastases and should receive systemic therapy. Despite treatment, majority of locally advanced patients develop metastatic disease. A retrospective analysis of cases of malignant melanoma registered over a period of eighteen years, from October 1990 to September 2007 was done. Patient profile, presentation, disease load, treatment protocols and response on or after treatment were analyzed. The median age at diagnosis in men was 48 years and 50 years in women. At presentation, more than half of studied cases [56.5%] presented with nodal metastases at diagnosis while about three fourths [74%] had distant metastases [stage IV disease]. More than half [56%] of the patients had superficial spreading type. The most common presenting complaints were swelling [70% of patients], ulcer [50% of patients] or pain [50%]. Primary sites included extremities, central nervous system, abdomen, trunk, and bones. Liver, brain, abdomen and lungs were common metastatic sites. Surgical excision of primary lesion was done in about half of the cases. Four patients subsequently received palliative radiotherapy and two more received adjuvant radiotherapy. Another six patients received adjuvant chemotherapy and radiotherapy. Among treated patients, 26% showed partial response and another 8% have stable disease while 65% patients progressed on or after initial treatment. Malignant melanoma carries an overall poor prognosis especially in advanced stages. Multimodality therapy with surgery, radiotherapy and chemotherapy may provide local or nodal remission but cannot improve long term survival in advanced cases

Beliefs and perceptions about cancers among patients attending radiotherapy OPD in Delhi, India.

The prevalence of beliefs and myths amongst cancer patients is a reflection of the level of knowledge in the community regarding cancer. Such beliefs influence the health seeking behaviour of patients and may lead to delay in seeking medical care. The present study revealed that myths and misconceptions are widely prevalent among cancer patients in India. The perception regarding causation of cancer among cancer patients varied from curses, evil eye and spirits to past sins. Only one third of the patients believed that cancer can be detected in its early stages and that it can be cured. The average time taken by patients to report to a doctor after suspecting their disease was 2 years. The majority of patients held fatalistic views about the outcome of cancer. Most (60%) were being discriminated against by their family and society. All these findings highlight that despite considerable medical knowledge of risk factors and treatment modalities, possible social-behavioral strategies for the prevention and control of cancer have not been adequately addressed, especially among South Asian patients.