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The Brown Bag Study
The material on this site was found in a brown bag in a storeroom. It formed the basis for a study by Dr. John Olivier in the late 1980’s. The results were not published; this failure to submit the material reflects on me, not Dr. Olivier. The cases actually date from the early 1950’s to the mid 1960’s. This material had been previously studied and the results published. As a supplement to the earlier studies, the lesions were evaluated by Breslow’s criteria. (John Olivier, Department of Pathology, Touro Infirmary, New Orleans, LA).
Acral lentiginous melanoma is the common melanoma of dark-skinned patients. A tendency for this lesion to be expressed in spindle cell patterns in vertical growth components is one of the distinguishing characteristics. Like common melanomas in other sites, it tends to have its origin in a precursor lesion; the precursor is expressed in lentiginous and junctional patterns, and in varying degrees of atypia. Like common melanomas, vertical growth components may be relatively solid, or loosely nested or fasciculated. Young (thin) examples may show minimal cytologic deviation, and some of the patterns in vertical growth qualify as minimal deviation, nevoid patterns. In the past, this lesion tended to present late in its evolution; it presented as a large, often ulcerated tumor; these characteristics are documented in this study. As a large lesion, the prognosis was poor.
The material in this study is old; some of the cases date back to the early 1950’s. The study documents progress in the treatment of melanoma. Over the period of this study, amputations gave way to wide local excisions. In the late 1950’s, perfusion was introduced as an adjunct (introduced at Tulane by Drs. Oscar Creech and Edward Krementz). Early on, lymph node dissections were performed at the time of the perfusions, or vice versa.
The old slides are not particularly photogenic. Why bother with this old material. In part, this material with representation of advanced lesions provides insights into progressive stages of neoplastic transformations; many of these lesions are polymorphic; in many examples, thevariations in patterns appear to document incremental stages of neoplasia. As an additional impetus, there may still be something to say about the histologic features of this variant of melanoma. There are no mucosal melanomas in this study but, in my experience, mucosal and acral lentiginous melanomas are closely related. Finally, like Eugene Field’s LITTLE BOY BLUE, the intention is to put my toys away. Unlike LITTLE BOY BLUE, who put his darlings away and then cautioned them not to go, and not to make any noise, mine have been placed on the web; they are free to go and the more noise, the better.
This material overlaps with material that has been reported from Charity Hospital of New Orleans in the 1960’s and 1970’s. Included in these studies is the original study of “acral lentiginous melanoma” (plantar melanoma) by Arrington, et al. The material in this section on this site supplements the earlier studies by providing an evaluation of histologic sections by the utilization of Breslow’s technique. Most of the lesions are so late in evolution that, even if Breslow’s measurement had been available in the 1950-60’s, the results would have had little impact on therapeutic decisions.
The reader is advised to go next to the “INDEX MAP,” the first textual chapter (i.e., chapter 2) at tier 2. The structure of the site is discussed; various aids to navigation are identified.
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