p53-independent NOXA induction overcomes apoptotic resistance of malignant melanomas

Once melanoma metastasizes, no effective treatment modalities prolong survival in most patients. This notorious refractoriness to therapy challenges investigators to identify agents that overcome melanoma resistance to apoptosis. Whereas many survival pathways contribute to the death-defying phenotype in melanoma, a defect in apoptotic machinery previously highlighted inactivation of Apaf-1, an apoptosome component engaged after mitochondrial damage. During studies involving Notch signaling in melanoma, we observed a gamma-secretase tripeptide inhibitor (GSI; z-Leu-Leu-Nle-CHO), selected from a group of compounds originally used in Alzheimer's disease, induced apoptosis in nine of nine melanoma lines. GSI only induced G2-M growth arrest (but not killing) in five of five normal melanocyte cultures tested. Effective killing of melanoma cells by GSI involved new protein synthesis and a mitochondrial-based pathway mediated by up-regulation of BH3-only members (Bim and NOXA). p53 activation was not necessary for up-regulation of NOXA in melanoma cells. Blocking GSI-induced NOXA using an antisense (but not control) oligonucleotide significantly reduced the apoptotic response. GSI also killed melanoma cell lines with low Apaf-1 levels. We conclude that GSI is highly effective in killing melanoma cells while sparing normal melanocytes. Direct enhancement of BH3-only proteins executes an apoptotic program overcoming resistance of this lethal tumor. Identification of a p53-independent apoptotic pathway in melanoma cells, including cells with low Apaf-1, bypasses an impediment to current cytotoxic therapy and provides new targets for future therapeutic trials involving chemoresistant tumors.

A retrospective study of 1- versus 2-cm excision margins for cutaneous malignant melanomas thicker than 2 mm.

BACKGROUND Most guidelines recommend at least 2-cm excision margin for melanomas thicker than 2 mm. OBJECTIVE We evaluated whether 1- or 2-cm excision margins for melanoma (>2 mm) result in different outcomes. METHODS This is a retrospective cohort study on patients with melanomas (>2 mm) who underwent tumor excision with 1-cm (228 patients) or 2-cm (97 patients) margins to investigate presence of local recurrences, locoregional and distant metastases, and disease-free and overall survival. RESULTS In all, 325 patients with mean age of 61.84 years and Breslow thickness of 4.36 mm were considered for the study with a median follow-up of 1852 days (1995-2012). There was no significant difference in the frequency of locoregional and distant metastasis between the 2 groups (P = .311 and .571). The survival analysis showed no differences for disease-free (P = .800; hazard ratio 0.948; 95% confidence interval 0.627-1.433) and overall (P = .951; hazard ratio 1.018; 95% confidence interval 0.575-1.803) survival. LIMITATIONS The study was not prospectively randomized. CONCLUSIONS Our study did not show any significant differences in important outcome parameters such as local or distant metastases and overall survival. A prospective study testing 1- versus 2-cm excision margin is warranted.

[Primary malignant melanoma of the parotid gland: a case report and review of the literature]

Malignant melanomas (MMs) of the parotid gland are relatively uncommon. They occur almost invariably as metastases from a primary tumour located in the region of the scalp or the mucous membranes of the nose, paranasal sinuses, or throat. Primary MMs arising in the parotid gland are extremely rare. It is assumed that they originate in the glandular tissue or in intraglandular lymph nodes. We present a case report and review of the literature on the diagnosis, treatment, and prognosis of intraparotid malignant melanoma. Diagnosis is based primarily on B-scan ultrasonography and fine-needle aspiration cytology. Patients with a cytological diagnosis of MM are further evaluated by magnetic resonance imaging and positron emission tomography and receive a thorough ear-nose-throat and dermatological examination. The treatment of choice is total parotidectomy and selective neck dissection. The effectiveness of adjuvant treatments such as radiotherapy, chemotherapy, or immunotherapy remains controversial. Patients with primary MMs of the parotid gland appear to have a better prognosis than those with parotid metastases from melanomas of the skin or mucous membranes.

The molecular cloning and characterization of human heparanase cDNA and the immunochemical localization of heparanase in metastatic melanomas

Heparanase, an endo-$\beta$-D-glucuronidase, has been associated with melanoma metastasis. Polyclonal antibodies directed against the murine N-terminal heparanase peptide detected a M$\sb{\rm r}\sim 97,000$ protein upon SDS-polyacrylamide gel electrophoresis of mouse melanoma and human melanoma cell lysates. In an indirect immunocytochemical study, metastatic human A375-SM and mouse B16-BL6 melanoma cells were stained with the anti-heparanase antibodies. Heparanase antigen was localized in the cytoplasm of permeabilized melanoma cells as well as at the cell surface of unpermeabilized cells. Immunohistochemical staining of frozen sections from syngeneic mouse organs containing micrometastases of B16-BL6 melanoma demonstrated heparanase localized in metastatic melanoma cells, but not in adjacent normal tissues. Similar studies using frozen sections of malignant melanomas resected from patients indicated that heparanase is localized in invading melanoma cells, but not in adjacent connective tissues.^ Monoclonal antibodies directed against murine heparanase were developed and characterized. Monoclonal antibody 10E5, an IgM, precipitated and inhibitated the enzymatic activity of heparanase. A 2.6 kb cDNA was isolated from a human melanoma $\lambda$gt11 cDNA library using the monoclonal antibody 10E5. Heparan sulfate cleavage activity was detected in the lysogen lysates from E. Coli Y1089 infected with the $\lambda$gt11 cDNA and this activity was inhibited in the presence of 10-fold excess of heparin, a potent inhibitor of heparanase. The nucleotide sequence of the cDNA was determined and insignificant homology was found with the gene sequences currently known. The cDNA hybridized to a 3.2-3.4 kb mRNA in human A375 melanoma, WI-38 fibroblast, and THP-1 leukemia cells using Northern blots.^ Heparanase expression was examined using Western and Northern blots. In comparison to human A375-P melanoma cells, the quantity of 97,000 protein recognized by the polyclonal anti-heparanase antibodies doubled in the metastatic variant A375-SM cells and the quantity of 3.2-3.4 kb mRNA doubled in A375MetMix, a metastatic variant similar to A375-SM cells. In B16 murine melanoma cell, the intensity of the 97,000 protein increased more than 2 times comparing with B16-F1 cells. The extent in the increase of the protein and the mRNA levels is comparable to the change of heparanase activity observed in those cells.^ In summary, the studies suggest that (a) the N-terminus of the heparanase molecule in mouse and human is antigenically related; (b) heparanase antigens are localized at the cell surface and in the cytoplasm of metastatic human and mouse melanoma cells; (c) heparanase antigens are localized in invasive and metastatic murine and human melanomas in vivo, but not in adjacent normal tissues; (d) heparanase molecule appeared to be differentially expressed at the transcriptional as well as at the translational level; and (e) the size of human heparanase mRNA is 3.2-3.4 kilobase. ^

Validation of Next Generation Sequencing Technologies in Comparison to Current Diagnostic Gold Standards for BRAF, EGFR and KRAS Mutational Analysis

Next Generation Sequencing (NGS) has the potential of becoming an important tool in clinical diagnosis and therapeutic decision-making in oncology owing to its enhanced sensitivity in DNA mutation detection, fast-turnaround of samples in comparison to current gold standard methods and the potential to sequence a large number of cancer-driving genes at the one time. We aim to test the diagnostic accuracy of current NGS technology in the analysis of mutations that represent current standard-of-care, and its reliability to generate concomitant information on other key genes in human oncogenesis. Thirteen clinical samples (8 lung adenocarcinomas, 3 colon carcinomas and 2 malignant melanomas) already genotyped for EGFR, KRAS and BRAF mutations by current standard-of-care methods (Sanger Sequencing and q-PCR), were analysed for detection of mutations in the same three genes using two NGS platforms and an additional 43 genes with one of these platforms. The results were analysed using closed platform-specific proprietary bioinformatics software as well as open third party applications. Our results indicate that the existing format of the NGS technology performed well in detecting the clinically relevant mutations stated above but may not be reliable for a broader unsupervised analysis of the wider genome in its current design. Our study represents a diagnostically lead validation of the major strengths and weaknesses of this technology before consideration for diagnostic use.

Tratamiento de Artritis reumatoide con antagonistas del factor de necrosis tumoral alfa y su asociación con el desarrollo de melanoma cutáneo: revisión sistemática de la literatura y meta-análisis.

Introducción: El tratamiento con antagonistas del factor de necrosis tumoral alfa (anti TNF) ha impactado el pronóstico y la calidad de vida de los pacientes con artritis reumatoide (AR) positivamente, sin embargo, se interroga un incremento en el riesgo de desarrollar melanoma. Objetivo: Conocer la asociación entre el uso de anti TNF y el desarrollo de melanoma maligno en pacientes con AR. Metodología: Se realizó una búsqueda sistemática en MEDLINE, EMBASE, COCHRANE LIBRARY y LILACS para ensayos clínicos, estudios observacionales, revisiones y meta-análisis en pacientes adultos con diagnóstico de AR y manejo con anti TNF (Certolizumab pegol, Adalimumab, Etanercept, Infliximab y Golimumab). Resultados: 37 estudios clínicos cumplieron los criterios de inclusión para el meta-análisis, con una población de 16567 pacientes. El análisis de heterogeneidad no fue significativo (p=1), no se encontró diferencia en el riesgo entre los grupos comparados DR -0.00 (IC 95% -0.001; -0.001). Un análisis adicional de los estudios en los que se reportó al menos 1 caso de melanoma (4222 pacientes) tampoco mostró diferencia en el riesgo DR -0.00 (IC 95% -0.004 ; -0.003). Conclusión: En la evidencia disponible a la fecha no encontramos asociación significativa entre el tratamiento con anti TNF en pacientes con diagnóstico de AR y el desarrollo de melanoma cutáneo.

Tyrosinase activated melanoma prodrugs

Metastatic malignant melanoma remains a highly aggressive form of skin cancer for which no reliable methods for treatment exist. Given the increasing incidence of this cancer, considerable attention has focused on the development of new and improved methods for tackling this disease. Within this article, methods for treating melanoma are reviewed and discussed with particular attention focusing on prodrugs that are activated by the tyrosinase enzyme. This enzyme is up-regulated and is of elevated activity within malignant melanomas compared with healthy melanocytes, providing an ideal in-situ tool for the activation of melanoma prodrugs. By way of background to the prodrug strategies discussed within this review, the causes of melanoma, the enzymology of tyrosinase, and the chemistry of the biosynthetic pathways associated with melanogenesis are presented. Aspects of the design, mode of action, and biological profiles of key prodrugs that are activated by tyrosinase, and that show potential for the treatment of melanoma, are then presented and compared.

Abdominal compression: A new intraoperative maneuver to detect chyle fistulas during left neck dissections that include level IV

Background Chyle fistulas may occur after left neck dissections that include level IV, due to injury of the thoracic duct or of 1 of its major branches. Despite being unusual, this complication carries substantial postoperative morbidity and even mortality. So far, no effective intraoperative maneuver has been reported to detect this fistula at the end of a neck dissection. In this cohort study, we sought to describe a simple new maneuver, intraoperative abdominal compression, which can effectively help to identify an open major lymphatic duct on level IV at the end of a neck dissection. Patients and Methods From March 1989 to September 2010, 206 patients underwent neck dissections involving left level IV, and underwent intraoperative abdominal compression. There were 119 men and 87 women, with ages ranging from 18 to 81 years (median, 52 years). One hundred forty-four patients had squamous cell carcinomas, 54 had thyroid carcinomas, 5 had malignant melanomas, and 3 had salivary cancers. Distribution by type of left neck dissection was: selective including levels II, III, and IV (73 cases; 35.4%), selective including levels II, III, IV, and V (55 cases; 26.6%), selective including levels I, II, III, and IV (12 cases; 5.8%), modified radical (47 cases; 22.8%), and radical (19 cases; 9.2%). In all cases, at the end of the procedure, the endotracheal tube was temporarily disconnected from the ventilator. Keeping the dissected level IV area under clear visualization, an abdominal compression was performed. At this moment, any detected lymphatic leak was carefully clamped and tied with nonabsorbable sutures. After ventilating the patient, the intraoperative abdominal compression was repeated to reassure complete occlusion of the lymphatic vessel. Results In 13 cases (6.3%), a chyle leak was detected after performing the intraoperative abdominal compression. All leaks except for 2 were successfully controlled after 1 attempt. In these 2 patients, a patch of muscle and fat tissue was applied with fibrin glue on the top. In 1 of these patients, another chyle leak in a different location was detected only at the second intraoperative abdominal compression, and was also effectively closed. Postoperatively, there were 2 (1%) chyle fistulas, both among these 13 cases, and all were successfully managed with clinical measures only. No fistulas occurred among the remaining 193 patients in whom intraoperative abdominal compression did not demonstrate lymphatic leak. Conclusion To our knowledge, this is the first description of a specific maneuver to actively detect a lymphatic fistula at the end of a left neck dissection involving level IV. In this study, intraoperative abdominal compression was able to detect an open lymphatic vessel in 6.3% of the cases, as well as to assure its effective sealing in the remaining 93.7% of the patients. Moreover, no life-threatening high-volume fistula was noted in this study. (C) 2012 Wiley Periodicals, Inc. Head Neck, 2012

Expression of BAG-1 and PARP-1 in Precursor Lesions and Invasive Cervical Cancer Associated with Human Papillomavirus (HPV)

Cervical cancer remains persistently the second most common malignancies among women worldwide, responsible for 500,000 new cases annually. Only in Brazil, the estimate is for 18,430 new cases in 2011. Several types of molecular markers have been studied in carcinogenesis including proteins associated with apoptosis such as BAG-1 and PARP-1. This study aims to demonstrate the expression of BAG-1 and PARP-1 in patients with low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs) and invasive squamous cell carcinomas (SCCs) of the uterine cervix and to verify a possible association with HPV infection. Fifty samples of LSILs, 50 samples of HSILs and 50 samples of invasive SCCs of the uterine cervix were analyzed by immunohistochemistry for BAG-1 and PARP-1 expression. PCR was performed to detect and type HPV DNA. BAG-1 expression levels were significantly different between LSILs and HSILs (p = 0,014) and between LSILs and SCCs (p = 0,014). In regards to PARP-1 expression, we found significant differences between the expression levels in HSILs and SCCs (p = 0,022). No association was found between BAG-1 expression and the presence of HPV. However, a significant association was found between PARP-1 expression and HPV positivity in the HSILs group (p = 0,021). In conclusion our research suggests that BAG-1 expression could contribute to the differentiation between LSIL and HSIL/SCC whereas PARP-1 could be useful to the differentiation between HSIL HPV-related and SCC. Further studies are needed to clarify the molecular aspects of the relationship between PARP-1 expression and HPV infection, with potential applications for cervical cancer prediction.

Untersuchungen zum Mechanismus der Zytotoxizität von alkylierenden Agenzien in malignen Melanomzellen

Maligne Melanome sind gegenüber Chemotherapeutika relativ resistent. Das methylierende Alkylanz Temozolomid sowie das chlorethylierende und DNA-Interstrand Crosslink (ICL) bildende Alkylanz Fotemustin kommen bei der Behandlung des malignen Melanoms als Mittel erster Wahl zum Einsatz. In der vorliegenden Arbeit konnte das erste Mal nachgewiesen werden, dass die zytotoxische Wirkung von Temozolomid und Fotemustin in Melanomzellen durch Apoptose vermittelt wird. Unter Verwendung klinisch relevanter Dosen der beiden Alkylantien konnte die Induktion von Apoptose durch vier unabhängige Methoden (Bestimmung der SubG1-Fraktion und der Apoptose- / Nekrose-Frequenz, Aktivierung der Effektorcaspasen-3 und -7 sowie Spaltung von PARP-1) nachgewiesen werden. Die Alkylierungen an der O6-Position des Guanins, welche durch beide Agenzien induziert werden, sind auch in Melanomzellen die wichtigsten Zytotoxizität-bewirkenden Läsionen in der DNA, und die O6-Methylguanin-DNA-Methyltransferase (MGMT) ist folglich ein herausragender Resistenzmarker. Eine der verwendeten Zelllinien (D05) exprimierte p53-Wildtypprotein. Diese Zelllinie war resistenter als alle anderen Zelllinien gegenüber Temozolomid und Fotemustin. Dies weist darauf hin, dass p53 nicht die Apoptoseinduktion in Melanomzellen verstärkt. Die Prozessierung des O6MeG erfolgt über die Mismatch-Reparatur (MMR) unter Generierung von DNA-Doppelstrangbrüchen (DSBs). Die Untersuchung der durch Temozolomid induzierten DSBs, nachgewiesen durch gammaH2AX-Induktion, korrelierte direkt mit der apoptotischen Antwort von Melanomzelllinien und DSBs können somit als eine entscheidende apoptoseauslösende Größe angesehen werden. Eine Resistenz gegenüber dem methylierenden Temozolomid in der Zelllinie MZ7 konnte auf einen Defekt in der MMR-Schadenserkennung auf der Ebene des MutSalpha-Komplexes zurückgeführt werden. Dieser Defekt hatte keinen Einfluss auf die Fotemustin-vermittelte Apoptoseinduktion. Neben MGMT konnte somit die MMR als Resistenzfaktor gegenüber methylierenden Agenzien in Melanomen identifiziert werden. Die Fotemustin-induzierte Apoptose wurde in Melanomzelllinien im Detail untersucht. Es konnte erstmals gezeigt werden, dass Fotemustin-bedingte ICLs in Zellen einen G2/M-Arrest im Behandlungszyklus induzieren. Wie anhand G1-arretierter Zellen nachgewiesen werden konnte, war das Durchlaufen der DNA-Replikation vor Erreichen des Arrests für die Induktion der Apoptose notwendig. Die Prozessierung von ICLs ist im Vergleich zu Methylierungen der DNA deutlich komplexer. Dies könnte erklären, warum in Melanomzellen die durch gammaH2AX-Induktion repräsentierten DSBs nicht mit der Sensitivität der einzelnen Zelllinien korreliert. Die Untersuchung unterschiedlich sensitiver Zelllinien zeigte ein vergleichbares Schadensniveau an ICLs und eine ebenso vergleichbare initiale Prozessierung derselben unter Generierung von DSBs. Die Prozessierung dieser sekundären Läsionen, welche anhand der Abnahme von gammaH2AX-Foci untersucht wurde, war hingegen in der sensitiveren Melanomzelllinie deutlich weniger effektiv. Es konnte weiterhin nachgewiesen werden, dass eine uneffektive Prozessierung der sekundären Läsionen einhergeht mit einer verstärkten und länger anhaltenden Aktivierung der in der DSB-Detektion beteiligten Kinase ATM und der Checkpoint Kinase 1. Es wäre daher denkbar, dass eine verstärkte Aktivität dieser Kinasen proapoptotische Signale vermittelt. Unterschiede in der Prozessierung der sekundären Läsionen könnten somit ein wichtiger Marker der ICL-induzierten Apoptose darstellen. Des weitern konnte nachgewiesen werden, dass nach Fotemustingabe die mitochondrial-vermittelte Apoptose einen effektiven Exekutionsweg in Melanomen darstellt. Während Cytochrom C-Freigabe, Bcl-2-Abnahme an den Mitochondrien, Bax-Rekrutierung und Caspase-9 Aktivität nachgewiesen werden konnten, wurden keine Hinweise auf eine Fas-Rezeptor-vermittelte Apoptose gefunden. Die Unfähigkeit, Rezeptor-vermittelte Apoptose zu unterlaufen, könnte die Bedeutungslosigkeit des p53-Gens in Melanomen begründen, da gerade dieser Weg in der Alkylantien-induzierten Apoptose in anderen Zellsystemen eine große Relevanz besitzt. Bei der Suche nach einem alternativen proapoptotischen Signalweg konnten Hinweise für die Beteiligung des Rb/E2F-1-Wegs, welcher über p73 agiert, in einer p53-mutierten Melanomzelllinie gefunden werden. Einen Einfluss der Proteine Survivin und XIAP als Resistenzfaktoren auf die Fotemustin-induzierte Apoptose wurde hingegen nicht nachgewiesen.

Untersuchungen zur antitumoralen Wirkungsweise eines bispezifischen MCSP-CD3 Antikörpers in vitro und im humanisierten Tumormausmodell

Humanes MCSP ist ein gut charakterisiertes Tumorantigen, das auf der Mehrzahl aller malignen Melanome hoch exprimiert wird, und stellt somit eine gute Zielstruktur für immuntherapeutische Ansätze dar. rnInnerhalb der vorliegenden Arbeit wurden die Wirkmechanismen eines neuen bispezifischen Antikörpers, der gegen humanes MCSP und CD3 auf T-Zellen gerichtet ist, in vitro und im humanisierten Tumormausmodell in vivo untersucht. In humanen T Zellkokulturen induzierte der bispezifische MCSP-CD3 Antikörper in Gegenwart MCSP-positiver Melanomzellen konzentrationsabhängige T-Zellaktivierung, Sekretion von Zytokinen und effiziente Tumorzelllyse durch CD4- und CD8-positive T-Zellen. Die induzierte Lyse war hierbei unabhängig von der T-Zellrezeptorspezifität sowie kostimulatorischen Molekülen und allein abhängig von der Expression des Tumorantigens sowie CD3 auf den T-Zellen. Wie hier diskutiert, liegt es nahe, dass die Freisetzung lytischer Moleküle (Perforin und Granzym-B) durch CD8- und auch CD4 positiver T-Zellen den Hauptmechanismus in der Lyse der Melanomzellen darstellt. rnUm die Wirksamkeit in vivo testen zu können, wurde ein humanisiertes Tumormausmodell etabliert. Die Injektion humaner hämatopoetischer Stammzellen in neugeborene Rag2-/-gc-/- Mäuse führte zur Entwicklung funktioneller T-Zellen im murinen Thymus, welche lymphatische Organe besiedelten. In vitro induzierten die T-Zellen humanisierter Mäuse in Anwesenheit des bispezifischen MCSP-CD3 Antikörpers ebenfalls konzentrationsabhängige Lyse der Melanomzellen. Wie hier gezeigt, induzierte die Injektion humaner Melanomzellen in humanisierte Mäuse keine messbare Abstoβungsreaktion. Unter Behandlung mit MCSP-CD3 wurde zwar eine erhöhte Anzahl humaner T-Zellen im Tumorgewebe nachgewiesen, jedoch verfügte die verwendete Melanomzelllinie über eine geringe basale T Zellinfiltration, geringe Vaskularisierung und ein noduläres Wachstumsverhalten. Wie innerhalb dieser Arbeit diskutiert, kann durch die Kombination mit Therapien, die eine erhöhte T-Zellinfiltration in das Tumorgewebe ermöglichen, die Wirksamkeit von bispezifischen Antikörpern möglicherweise gesteigert werden. rn

Metastatic disease to the parotid gland

OBJECTIVES: The purpose of this study was to review the clinico-pathologic findings and outcome of patients with metastasis to the parotid lymph nodes and gland. METHODS: Retrospective study. Thirty-four out of 520 patients with a parotid mass treated at our institution met the criteria for this study. Age, gender, clinical findings, histopathology, treatment. and outcome were analyzed. RESULTS: Twenty-three patients had metastases to parotid lymph nodes from a squamous cell carcinoma of the skin, seven from a cutaneous malignant melanoma after a mean interval of 15 months, two from a ductal breast carcinoma, one with a metastatic disease from a rhabdomyosarcoma of the lower limb, and one from a Merkel cell carcinoma. The 5-year cause-specific and absolute survival for squamous cell carcinoma was 64% and 48% respectively and 71% and 57% for malignant melanomas. CONCLUSIONS: Metastatic disease to the parotid gland is mostly caused by squamous cell carcinoma. Despite combined treatment modalities long-term survival remains poor.

Excision of fascia in melanoma thicker than 2 mm: no evidence for improved clinical outcome.

BACKGROUND Lack of evidence-based data causes significant variation among surgeons concerning the depth of wide excision for primary cutaneous melanomas. OBJECTIVES To evaluate the clinical effect of excision of the deep fascia in melanomas thicker than 2 mm on patient outcome. METHODS We performed a retrospective cohort review (1996-2012) of patients with melanomas thicker than 2 mm. Included patients underwent excision with a 1-cm margin. Data collected included the patients' sex, age, tumour location, tumour type, Breslow depth and presence of ulceration. Local recurrences, locoregional and distant metastases, and disease-free and overall survival were compared between the fascia-excised and the fascia-preserved groups. RESULTS Out of 2182 patients with malignant melanomas, 213 melanomas thicker than 2 mm, with a median follow-up of 1547 days, were included. The mean age of the patients was 62·6 years and the mean Breslow depth was 4·2 mm. Analysis of data for death attributable to melanoma (P = 0·72), local recurrence (P = 0·71), and locoregional (P = 0·87) and distant metastases (P = 0·34) were not significantly different between the study groups. Furthermore, Kaplan-Meier and Cox regression analysis of both groups showed no evidence of significant difference regarding disease-free [P = 0·35; hazard ratio (HR) 1·25; 95% confidence interval (CI) 0·79-1·97] and overall survival (P = 0·63; HR 1·18; 95% CI 0·61-2·27). CONCLUSIONS We believe that excision of the deep fascia does not improve the outcome of melanomas thicker than 2 mm.

Changes in expression of putative antigens encoded by pigment genes in mouse melanomas at different stages of malignant progression.

Cutaneous melanomas of Tyr-SV40E transgenic mice (mice whose transgene consists of the tyrosinase promoter fused to the coding regions of simian virus 40 early genes) strikingly resemble human melanomas in their development and progression. Unlike human melanomas, the mouse tumors all arise in genetically identical individuals, thereby better enabling expression of specific genes to be characterized in relation to advancing malignancy. The products of pigment genes are of particular interest because peptides derived from these proteins have been reported to function as autoantigens with immunotherapeutic potential in some melanoma patients. However, the diminished pigmentation characteristic of many advanced melanomas raises the possibility that some of the relevant products may no longer be expressed in the most malignant cells. We have therefore investigated the contributions of several pigment genes in melanotic vs. relatively amelanotic components of primary and metastatic mouse melanomas. The analyses reveal marked differences within and among tumors in levels of mRNAs and proteins encoded by the wild-type alleles at the albino, brown, slaty, and silver loci. Tyrosinase (the protein encoded by the albino locus) was most often either absent or undetectable as melanization declined. The protein encoded by the slaty locus (tyrosinase-related protein 2) was the only one of those tested that was clearly present in all the tumor samples. These results suggest that sole reliance on targeting tyrosinase-based antigens might selectively favor survival of more malignant cells, whereas targeting the ensemble of the antigens tested might contribute toward a more inclusive and effective antimelanoma strategy.