Melanosis in association with metastatic malignant melanoma: report of a case and a unifying concept of pathogenesis.

An unusual case of melanosis associated with metastatic malignant melanoma is reported. This was characterized by progressive blue/gray discoloration of the skin of the chest and abdomen in an elderly patient, 1 year after removal of a polypoid malignant melanoma from the right arm. A biopsy of involved skin revealed perivascular aggregates of melanin-laden histiocytes throughout the dermis, the histopathologic hallmark of melanosis. An unusual aspect of the case was the coincidental finding of a tumor embolus within a small dermal vessel, probably a lymphatic. To date, neoplastic melanocytes have been detected in only a small minority of skin biopsies with features of melanosis. This case and a distillation of related information in the literature lead to the conclusion that the essence of melanosis, and the feature that distinguishes this from conventional metastatic melanoma, is the persistent and cumulative dissemination of melanin, via the bloodstream, throughout the body. This in turn leads to progressive pigmentation of all internal organs and the skin. Only continuous access to the circulation by neoplastic melanocytes could explain such a phenomenon. Potential mechanisms by which this could arise are discussed in the context of existing knowledge.

A phase II survival comparison of patients with adenocarcinoma of the pancreas treated with 5-fluorouracil and calcium leucovorin versus a matched tumor registry control population.

Carcinoma of the pancreas is a virulent malignancy. We performed a Phase II survival study by treating 30 patients with pancreatic cancer with leucovorin, 200 mg/m2 x 5 days immediately followed by 5-fluorouracil, 370 mg/m2 every 4 weeks. We examined the survival of our 30 study patients with patients drawn from the Manitoba Tumor Registry, matched for important prognostic criteria. Classical response rates were also evaluated in those patients who had measurable tumors. The response rate was 13% with two complete remissions and one partial remission, with 40 patients (7.8%) demonstrating stable disease for 2 months, and 39% of patients demonstrating progressive disease while on treatment. The mean survival of the Phase II-treated group was 16 weeks, compared to 12 weeks in the matched controls, which indicated an increase in survival of 30%. This was significant at the p = .001 level. Toxicity was not as great as expected. This trial demonstrates that there may be marginal survival benefit with 5FU leucovorin in pancreatic cancer, but more profound prolongation needs to be seen with chemotherapy regimens before instituting randomized trials.

A review of the oncology curriculum at Dalhousie medical school.

The teaching of oncology at Dalhousie medical school is currently left to the discretion of the 30 university departments. There is no central coordination. This organization leaves no monitoring of curriculum content to see that what should be covered is indeed covered, nor does it provide teaching from the perspective of oncology rather than the perspective of the other individual disciplines. Following an inventory of the oncology curriculum and a survey of interns graduating from Dalhousie in 1991, we recognize deficiencies in the clinical portion of the curriculum that could be rectified with a small number of hours designed to teach the various aspects of the management of cancer patients in case-scenario, student participation sessions.

A phase II study of idarubicin in the treatment of measurable gastric cancer.

Idarubicin is one of the new anthracycline analogues. It has a higher therapeutic index than either doxorubicin or daunorubicin in a variety of murine leukemias and solid tumors. The authors performed a multicenter Phase II trial of idarubicin in patients with advanced gastric cancer. Seventeen patients with measurable metastatic disease were entered into the trial and treated with idarubicin at a starting dose of 15 mg/m2. This dose was escalated or reduced according to toxicity. There were no documented responses. The dose-limiting toxicity was myelosuppression. These data did not compared favourably with the data on doxorubicin in the treatment of gastric carcinoma. A conclusion could not be reached on whether idarubicin has minimal activity in the treatment of gastric carcinoma.

Phase II study of trimetrexate in recurrent anaplastic glioma. National Cancer Institute of Canada Clinical Trials Group Study.

The National Cancer Institute of Canada Clinical Trials Group conducted a phase II trial of trimetrexate given in a daily x 5 intravenous bolus schedule every 3 weeks in patients with measurable recurrent anaplastic glioma and limited prior treatment. There were no responses in 14 evaluable patients. We conclude that trimetrexate, given as described, is not an active agent in this disease.

Decision making in cancer treatment: age and socio-economic status as independent variables.

Treatment decision making in cancer patients is dependent on tumour variables, patient variables, and physician bias. Patient age and socio-economic status were examined as independent variables in treatment decision making. Bias towards offering treatment options to younger, more socially active patients was found.

The changing incidence of cancer of the oesophagus in Lesotho: real or improved diagnostic ability.

Cancer of the oesophagus has previously been reported as an exceedingly rare tumour in the Kingdom of Lesotho. This is in marked contrast to the extremely high incidence in the neighbouring South African homeland, Transkei. During 1984, gastroscopy was used as a diagnostic tool in determining a more accurate estimation of the true incidence of oesophageal cancer in Lesotho, and more specifically in the capital region of Maseru. The results of this study revealed that the incidence of this disease in Lesotho approaches that of the Transkei.

Cyclophosphamide, doxorubicin, and vincristine in etoposide- and cisplatin-resistant small cell lung cancer.

For two chemotherapy regimens to be truly non-cross-resistant, each should be active as first-line therapy and also as second-line therapy. The effectiveness of both cyclophosphamide, doxorubicin, and vincristine (CAV) and etoposide and cisplatin (VPP) in previously untreated patients with small cell lung cancer has been well-documented. Also, VPP has caused tumor regression in up to 50% of patients when used as second-line therapy after CAV. The effectiveness of CAV after progression or relapse after VPP has not been documented. We identified 29 patients who received CAV after their tumors failed to respond or relapsed after VPP or etoposide and carboplatin (VPC). There were 21 male and eight female patients (median age, 57 years; range, 30-79). Thirteen patients were treated following failure to respond to VPP or VPC and 16 at the time of relapse. Eight patients had limited disease and 21 had extensive disease. Metastatic sites included liver (11 patients), bone (ten), lymph nodes (seven), bone marrow (three), brain (four), and contralateral lung (one). There were three complete responses (durations of 16, 22, and 26 weeks) and five partial responses (duration, 8+ to 36 weeks). Three patients had stable disease and 18 patients had disease progression while receiving treatment. The median survival of the entire group was 15 weeks. Responding patients had a median survival of 34 weeks (range, 8+ to 72+) and stable and nonresponding patients had a survival of only 9 weeks (range, 2-38). A granulocyte count nadir less than 500 X 10(9)/L was seen after 7.9% of evaluable treatment cycles and a platelet count nadir less than 50,000 X 10(9)/L occurred after only 5.3% of cycles. Five patients required transfusion for anemia, and two patients required dose reduction of vincristine for peripheral neuropathy. This study demonstrates that CAV has limited activity following failure to respond to VPP.