Clinical Experiences in Malignant Melanoma

ABSTRACT

Malignant melanoma has shown a dramatic increase in its incidence in the last two decades in the western hemisphere, but it is still rare in Korea. We respectively reviewed the medical records of 10 melanoma patients who had been admitted to and treated at Daedong Hospital between January 1986 and December 1996. The age of the patients was between 26 and 81 (average 60). There were 4 men and 6 women, most often over the fifth decade of life. Malignant melanoma was common in the extremities, especially the acral portion of the lower extremities 4 in the sole, 2 in the dorsum of the foot, 1 in the palm, 1 in the thumb, 1 in the neck, and 1 in the anus. The sizes of the melanoma were from 0.4 cm to 4.5 cm in diameter and depths of invasion were from 0.8 mm to 6 mm microscopically. According to the TNM staging of the American Joint Committee on Cancer, the distribution of the patients was one for IB, two for IIA, two for III, and four for IV. In one case, the staging was difficult. Wide excision with skin graft was carried out in six patients with a 2-cm excision margin. Another two patients were treated with a 1-cm excision margin. In the other two patients, the melanoma was found in the biopsy of the cervical lymph node and in the widely excised anus. Elective inguinal lymph node dissection was carried out around the femoral and the external iliac arteries in 3 patients whose inguinal lymph nodes were palpated during physical examination. One patient with an anal lesion was vaccinated with BCG, but without much benifit. One patient was treated with radiation and chemotherapy, but he suffered brain metastasis. Four patients with stage IV melanoma died due to metastasis to the brain or the iver. The others were being follow up. Supportive treatments were under investigation, therfore early detection followed by wide excision is the best way to obtain a better outcome in malignant melanoma.