Melanotic Freckle Research Articles

Enhanced radiotolerance to ionizing radiation is correlated with increased cancer proneness of cultured fibroblasts from precursor states in neurofibromatosis patients

We have determined the sensitivity to gamma rays of cultured fibroblasts derived from clinically defined areas on the skin of neurofibromatosis patients. Fibroblasts from skin of normal appearance were normally sensitive to gamma irradiation. Significantly, however, fibroblasts from café-au-lait lesions and from neurofibromas were abnormally radiotolerant (about twofold) to treatment with gamma rays. This was seen in specimens taken from the same patient, as well as from different patients, within four different neurofibromatosis pedigrees. In contrast, no differences in radiosensitivity have been observed between fibroblasts derived from skin of normal appearance and those obtained from melanotic freckles of individuals with no family history of cancer. The results suggest that increased propensity to cancer in this cell system is associated with increased radiotolerance to ionizing radiation.

Relationship of Cutaneous Malignant Melanoma to Individual Sunlight-Exposure Habits<xref ref-type="fn" rid="FN2">2</xref><xref ref-type="fn" rid="FN3">3</xref>

The relationships of different histologic types of cutaneous malignant melanoma to occupational and recreational sunlight exposure, habits of clothing, sunburn histories, and use of sunscreening agents were examined in a case-control study of 507 patients and 507 matched controls in Western Australia. Variations in relationships according to the primary site of melanoma were also examined. An increased incidence rate of superficial spreading melanoma was associated with low total outdoor exposure in early adulthood and frequent participation in boating and fishing. Superficial spreading melanoma of the trunk was also related to frequency of sunbathing at ages 15-24 years and of exposure of the trunk while working outdoors. In women the rate ratio for all types of melanoma occurring on the trunk was estimated at 13.0 (95% confidence interval, 2.0-83.9) in those who wore a bikini or bathed nude at ages 15-24 years compared with those wearing a conservative one-piece bathing suit. There was little evidence that sunbathing or wearing a bikini within 10 years of case diagnosis were risk factors for melanoma of the trunk. After control of confounding due to constitutional factors, only Hutchinson's melanotic freckle melanoma showed a relationship to severe sunburn. For nodular melanoma, sunburn appeared to be protective. Although many of the results supported the hypothesis that melanomas other than the Hutchinson's melanotic freckle type are related to occasional bursts of recreational sun exposure during a susceptible period in early adult life, little support for the hypothesis was obtained when recreational sun exposure was expressed as a proportion of total outdoor exposure, which had been considered a priori to be an index of intermittent sunlight exposure.

Melanoma in Western Australia 1975-76 to 1980-81: trends in demographic and pathological characteristics.

Trends in incidence rates of cutaneous malignant melanoma in Western Australia from 1975-76 to 1980-1981 have been examined with reference to age, sex, body site, presence or absence of dermal invasion, tumour thickness, histological type, socioeconomic status and occupation. The incidence rates of all melanomas increased from 22.1 to 31.5 per 100,000 person-years in males and from 23.6 to 28.6 in females. In males, the relative annual increase in the incidence of invasive melanoma was 2.2%, and in females it was 5.6%. In-situ melanomas had larger relative increases in incidence (28% per annum in males and 10% in females) and the thickness of invasive lesions decreased between 1975-76 and 1980-81. The relative increase in incidence of invasive melanomas was greatest on the body sites with the highest rates initially--the trunk in males and the lower limbs in females. There was an increase in the proportion of invasive lesions classified as superficial spreading melanoma. The increase in incidence of in situ melanomas was largely restricted to the head and neck in older men of high socioeconomic status resident in Perth. This trend in in-situ melanoma was mainly due to an increase in the recorded incidence of Hutchinson's melanotic freckle. It may have been, in part, an artefact due to increased recognition of Hutchinson's melanotic freckle in this sub-group of the population.

Hutchinsonʼs melanotic freckle melanoma associated with nonpermanent hair dyes

Hutchinsonʼs melanotic freckle melanoma associated with nonpermanent hair dyes

Cutaneous malignant melanoma in western australia

The first detailed epidemiological and histological studies of cutaneous malignant melanoma in Western Australia have been undertaken recently. High and, apparently, increasing annual incidence rates have been confirmed (1975/76: 23.0/100 000 in males, 25.0/100 000 in females. 1980/81: 28.9/100 000 in males, 31.5/100 000 in females--rates for pre-invasive and invasive lesions combined). The results support a causal relationship of sunlight exposure with cutaneous melanoma in general, while suggesting that melanoma of Hutchinson's melanotic freckle type is related to continuous sun exposure whereas intermittent exposure is more important in the etiology of melanoma of superficial spreading type. The proposed etiological heterogeneity of melanoma and the dual origin theory of Mishima have been embodied in a theory of the etiology and histogenesis of melanoma which proposes that nodular melanoma is a common end result of the other types of melanoma rather than a distinct histogenetic entity. Some components of this theory have been supported by results of the 1980/81 West Australian Lions Melanoma Research Project. The overriding importance of tumour thickness as the most accurate histologic index of prognosis yet available has been emphasized by correlation with survival rates in Western Australia and the Oxford Region. Tumour thickness has also been shown to be the most reproducible of histological features, while others were subject to considerable interobserver variation. The better prognosis for melanoma patients in Western Australia compared with low incidence regions, when correlated with tumour thickness, indicated that melanoma is diagnosed earlier in areas of high incidence due to greater awareness of the risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Cutaneous Malignant Melanoma and Indicators of Total Accumulated Exposure to the Sun: An Analysis Separating Histogenetic Types<xref ref-type="fn" rid="FN2">2</xref>

Evidence associating malignant melanoma with semiquantitative and questionnaire indicators of past sunlight exposure is presented from a case-control study of 511 patients and 511 matched control subjects in Western Australia. That melanoma is related to sun exposure was supported by associations with actinic skin damage graded by cutaneous microtopography, history of nonmelanotic skin cancer, duration of residence of migrants to Australia, and mean annual hours of bright sunshine received at locations where the subjects had resided. Separate analyses of histogenetic subtypes revealed that Hutchinson's melanotic freckle melanoma had the strongest associations with indicators of sunlight exposure. For superficial spreading melanoma, a specific relationship was observed with age at arrival as against duration of residence in Australia. Migrants arriving before age 10 years appeared to have a risk similar to that of native-born Australians, whereas the estimated incidence in those arriving after age 15 years was around one-quarter of the native-born rate, with arrival at later ages giving no additional advantage. Control subjects arriving in Australia before age 10 years had an increased number of nevi on their arms, suggesting that sun exposure in early life may be a factor in nevus production and, therefore, a determinant of later potential to develop superficial spreading melanoma.

Hutchinson's melanotic freckle melanoma associated with non-permanent hair dyes.

Les substances chimiques des colorants non permanents pour cheveux augmente le risque de melanome de Hutchinson. Ce melanome resulterait d'une accumulation de la lesion produite par le rayonnement UV dans le genome des melanocytes alors que le melanome a extension superficielle peut se former a partir des cellules initiees des naevi pigmentes qui subissent une promotion par l'exposition intermittente au soleil et d'autres agents

The diagnosis of hutchinson’s melanotic freckle (lentigo maligna) in queensland

Following an increase in the reported incidence of melanoma of Hutchinson's melanotic freckle type (HMFM) in Queensland, a review of its histological diagnosis was undertaken. Ninety-nine pigmented lesions reported by 13 different pathology laboratories throughout Queensland as having an in-situ component of Hutchinson's melanotic freckle (HMF) were reviewed by 2 pathologists with an interest in malignant melanoma. This diagnosis was confirmed in 76 cases while in a further 3 the reviewers regarded the in-situ component as indeterminate. It would seem that the level of agreement among pathologists reporting HMF(M) should be considered in any assessment of incidence patterns of melanoma.

Melanoma of the head and neck in Queensland.

The incidence of melanoma in Queensland, 40 cases per 100,000 population, is the highest in the world. In this series of 740 melanomas over a 7-year period at the Royal Brisbane Hospital, 21.75% occurred on the head and neck. Of these, 46.5% arose in Hutchinson's melanotic freckle and 54.8% were histologically superficial, that is, Clark Levels I and II or less than 0.76 mm in thickness, or both. As local recurrence and distant metastasis is infrequent in superficial melanoma, less radical surgical excision of these lesions is advocated than for thicker lesions or those exhibiting a greater depth of invasion, where aggressive excision and even regional node dissection may be required. Anatomical variations in areas such as the nose, eyelid, ear, and scalp influence patterns of spread and necessitate differences in treatment at each site.

Epidemiology of pre‐invasive and invasive malignant melanoma in Western Australia

AbstractThe annual incidence rates of melanoma in Western Australia in 1975 and 1976 were estimated, by reference to hospital and pathology records. They were 4.4/ 100,000 in males and 6.2/100,000 in females for pre‐invasive lesions and 18.6/100,000 and 18.8/100,000 for invasive lesions. Rates specific to particular body sites showed two distinct patterns of change with age ‐ a progressive rise beginning about age 40 years (shown by Hutchinson's melanotic freckle and invasive melanoma of the head and neck) and an early rise beginning about age 20 years with a peak in middle‐life and subsequent stabilization or decline (shown by superficial spreading melanoma, non‐invasive and invasive melanoma of the lower limbs and, less typically, trunk and upper limbs). Incidence rates were highest in native‐born Australians and higher in immigrants of British origin than in other immigrants. The rates in British immigrants were more than double those in the British Isles. The incidence was highest in residents of high social class areas, and in in‐door rather than outdoor workers. Rates were also highest in the capital city, Perth, and the south‐west corner of the State, rather than in the north where exposure of the population to ultra‐violet light might be expected to be highest. In most of these respects the patterns for pre‐invasive and invasive lesions were similar. Aspects of these data are inconsistent with the solar hypothesis of melanoma aetiology. It is suggested, however, that some of these inconsistencies may be explained if intermittent, intense exposure to the sun were more relevant to the aetiology of melanoma than continuous exposure.

Treatment of Hutchinson's melanotic freckle

Treatment of Hutchinson's melanotic freckle

CHANGING EPIDEMIOLOGY OF MALIGNANT MELANOMA IN QUEENSLAND

Information provided by Queensland pathology laboratories shows that the annual incidence of cutaneous malignant melanoma in Queensland has doubled from 16 per 100 000 population in 1966, to 32.7 per 100 000 in 1977. The incidence in males, and the males to females ratio have increased. The major sites of the tumour remain the same, except possibly for a reduction in the number of leg tumours in females in tropical Queensland. More tumours with an in-situ component of Hutchinson's melanotic freckle type are being diagnosed. The tumours diagnosed in 1977, compared with those in the Queensland Melanoma Project files from 1963 to 1969, are more superficial (Level 1 or Level 2), with nonelevated profile and smaller diameter. The findings suggest that the disease is being diagnosed and treated earlier.

Melanotic freckle of Hutchinson: treatment of macular and nodular phases with cryotherapy.

Fourteen cases of Hutchinson's lentigo maligna and eight further cases with nodular invasive areas in whom liquid nitrogen spray has been curative are reported. We suggest that in view of its simplicity and efficacy, cryotherapy is the treatment of choice for the macular phase and possibly also for the nodular invasive stage.

Cellular immunecompetence in patients with malignant melanoma

The nonspecific immunecompetence of the peripheral blood lymphocytes of 29 patients with malignant melanoma and one with the benign condition of Riehl's melanosis was tested by means of a local xenogeneic graft-versus-host reaction and the E rosette test. The lymphocytes of 20 normal donors served as controls. Impairment of cellular immunecompetence was found in patients with invasive multiple primaries and those with invasive nodular malignant melanoma. Functional activity of T lymphocytes was normal in most of the patients who had an invasive melanoma with adjacent intraepidermal component of Hutchinson melanotic freckle or superficial spreading. In three cases with superficial spreading in which there had been an impairment of T cell function before removal of the tumor, there was an improvement following surgery. There was a clear correlation between the patient's cell-mediated immune response and the pathological type of the tumor, but not with the depth of invasion. It is suggested that cellular immunecompetence is a valuable parameter in the prognosis and treatment of malignant melanoma and should be measured in all patients with this type of tumor.

Current Management of Melanoma

EVEN THOUGH CARSWELL first used the term melanoma in a treatise in the early part of the 19th century, Hippocrates is credited with the first recorded clinical observation of cutaneous melanoma. During the seventeenth century several reports appeared in the literature referring to the “fatal black tumor.‘’ In 1806 both Laennec and Dupuytren published on melanosis; however, it was not until 1864 that Sir James Paget stated that cancer could develop in a mole. In 1892 Hutchinson published his Archives of Surgery in which he carefully described the senile freckle which we now call Hutchinson's melanotic freckle. A decade ago Clark2 formulated the classification utilized throughout the world today. He described three separate types: 1) melanoma, Hutchinson's melanotic freckle type (lentigo maligna melanoma), 2) melanoma, invasive with adjacent intraepidermal component of superficial spreading type (superficial spreading melanoma), 3) melanoma, invasive, without adjacent intraepidermal component (nodular melanoma).

Cryosurgery for unusual cutaneous neoplasms.

Cryosurgery is used effectively to treat several unusual cutaneous tumors, namely, four cases of lentigo maligna (melanotic freckle of Hutchinson, or circumscribed precancerous melanosis of Dubreuilh), one case of pseudopyogenic granuloma of Wilson Jones, and one case of granuloma faciale.

Treatment of melanotic freckles by radiotherapy.

Uncomplicated cases of melanotic freckles respond well to radiotherapy with grenz rays. If, however, a conversion into melanoma is in progress or already established, the prognosis is poorer and treatment with harder rays combined with surgical excision should be practiced.

Treatment of melanotic freckle with X-rays

Treatment of melanotic freckle with X-rays

Malignant melanoma with adjacent hutchinson's melanotic freckle in black Africans

Hutchinson's melanotic freckle (lentigo maligna) is a well-known pigmented lesion, usually seen on the face of white patients. It may be associated with invasive malignant melanoma. This paper reports the incidence of this lesion in association with invasive malignant melanomas of the feet and hands of Black Africans. In Blacks, as in Whites, malignant melanoma with adjacent Hutchinson's melanotic freckle carries a considerably better prognosis than other histogenetic patterns of malignant melanoma.

Malignant Melanomas of the Conjunctiva

A retrospective study of 23 conjunctival melanomas using the Clark classification revealed that the three most common forms of melanoma described in the skin--lentigo maligna melanoma (Hutchinson's freckle with melanoma), superficial spreading melanoma, and nodular melanoma--can be recognized in the conjunctiva. As in the skin, lentigo maligna melanoma appears to be associated with a good prognosis compared to the prognosis associated with superficial spreading melanoma. These two forms of melanoma are both associated with an intraepithelial stage and had previously been grouped under one designate, cancerous melanosis. They can be distinguished histologically although definite clinical differentiation will be determined in the future. Some melanomas with an intraepithelial stage, however, cannot be definitely classified. Relating all conjunctival cancerous melanoses to Hutchinson's melanotic freckle is no longer justified.