Skin test results with common and melanoma antigens compared to clinical outcomes of melanoma patients treated with intralesional (IL) dinitrochorobenzene (DNCB) or IL bacillus Calmette-Guerin (BCG).

Abstract

59 Background: In a previous study involving in vitro serial testing in patients receiving IL BCG or IL DNCB we determined that measurements of serial in vitro phytohemagglutinin stimulation levels correlated with the patients’ clinical courses. The current evaluation attempted to determine which in vivo skin test studies were useful in this setting. Methods: All patients had locally progressive melanoma satellosis, or in-transit metastases, but no evidence of distant metastasis past regional lymph nodes. Patients had been randomized to repeatedly receive either IL BCG (9 patients), or IL DNCB (9 patients) into cutaneous or subcutaneous metastases. A "BCG worse outcome group" consisted of 6 patients in whom distant metastasis was detected within 2 to 20 months, and who died within 9 to 24 months. A "BCG better outcome group" consisted of 3 patients who were alive and in whom no distant metastases were detected after 12 to 39 months. Similarly, the 9 patients randomized to be treated with intralesional DNCB were also subsequently divided into two groups: A "DNCB worse outcome group" consisted of 6 patients in whom distant metastasis was detected within 5 to 11 months, and who died within 6 to 12 months. A "DNCB better outcome group" consisted of 3 patients who were alive and in whom no distant metastases were detected after 8 to 20 months. Following informed consent, patients were serially skin tested, as possible, with Purified Protein Derivative antigen (PPD), Mumps antigen, Streptokinase/Streptodornase (SKSD), and inactivated melanoma extracts, using coded syringes. Results: In comparing the two "better outcome" groups with the two "worse outcome" groups, patients who prior to treatment had a positive reaction to melanoma extracts appeared to fare better than those who did not. All patient groups tended to react positively to SKSD, a general sign of immune capability. Conclusions: Among the skin tests compared, testing with melanoma extract appeared to correlate best with clinical courses in patients undergoing BCG or DNCB intralesional treatments for progressive melanoma satellosis or in-transit metastases.