Showing papers in "Journal of Surgical Oncology in 1980"
TL;DR: The clinicopathologic features of 118 granular cell tumors encountered at two affiliated hospitals were reviewed and it was found that Schwann cell origin is favored in most cases.
Abstract: The clinicopathologic features of 118 granular cell tumors (GCT) encountered at two affiliated hospitals were reviewed. A total of 110 patients were affected over this 32-year period of study (71 men, 39 women), and in 5% GCT were multiple. Patients ranged in age from 16 to 58 years (average 32 years) and were symptomatic for an average duration of 11 months prior to diagnosis. There was a greater than expected frequency of GCT among black patients (29%). Although tongue was the single most common anatomic site involved, relatively more GCT (44%) occurred in skin or subcutaneous tissue. Less common locations were breast parenchyma (10 cases), rectal mucosa and anus (6), vulva (4), esophagus and larynx (2 cases each). The correct preoperative diagnosis of this protean tumor was made in only three patients. GCT were surgically treated with the average diameter of resected tumor being 1.2 cm (range 0.2--3.5 cm). Pseudoepitheliomatous hyperplasia was noted in 11 tumors and in one vulvar GCT there was overlying in situ squamous cell carcinoma. Tumors were incompletely excised in 24 of 56 patients having adequate followup; only five of these 24 patients experienced a local recurrence of tumor. Malignant behavior was not observed. Results of histochemical and ultrastructural study are briefly discussed. The precise histogenesis of GCT is uncertain but Schwann cell origin is favored in most cases.
526 citations
TL;DR: The clinical manifestations and the biological nature of this tumor are analyzed in detail, along with treatmentRecommendations for treatment of juvenile nasopharyngeal angiofibroma are discussed.
Abstract: Seven cases of juvenile nasopharyngeal angiofibroma were seen in the Division of Radiation Oncology of the Department of Human Oncology, University of Wisconsin Hospitals from 1961 to 1977. The method of treatments and the end results are discussed. The clinical manifestations and the biological nature of this tumor are analyzed in detail, along with treatment recommendations.
154 citations
TL;DR: Administration of indomethacin caused complete resolution of a desmoid tumor after a partial response to radiation and in another patient, this drug caused an immediate response, then became ineffective.
Abstract: Administration of indomethacin caused complete resolution of a desmoid tumor after a partial response to radiation. In another patient, this drug caused an immediate response, then became ineffective. When large doses of ascorbic acid were given with indomethacin, slow resolution of the tumor began and has continued for 14 months. Treatment of a third case with indomethacin and ascorbic acid from the beginning produced shrinkage of the tumor which has continued to date.
141 citations
TL;DR: The difference noted between the mean serum Se concentrations of breast cancer patients and controls were found to be significant and the addition of Se to the diet has been shown to decrease the incidence of spontaneous murine mammary tumors.
Abstract: An inverse relationship exists between dietary selenium (Se) concentrations and the incidence of human breast cancer. The addition of Se to the diet has been shown to decrease the incidence of spontaneous murine mammary tumors. We compared the serum Se concentrations in breast cancer patients with those of women without breast cancer. Serum was collected from 35 women with breast cancer. Nineteen of these women had infiltrating ductal carcinoma and two had Paget disease of the nipple. Nine women had lymph nodal metastases at the time of mastectomy, four had definite evidence of metastatic disease when the blood samples were drawn, and the disease process of one patient was unclassified. Samples from 27 women known to be free of breast cancer were used as controls. The difference noted between the mean serum Se concentrations of breast cancer patients and controls were found to be significant.
75 citations
TL;DR: This is retrospective and all inclusive study of 925 patients who had isolated lymph node biopsies for diagnosis from 1973 to 1977, finding that age is the most important factor useful in estimating the probability of whether the lymphadenopathy is due to a benign or malignant process.
Abstract: This is a retrospective and all inclusive study of 925 patients who had isolated lymph node biopsies for diagnosis from 1973 to 1977. Overall, 60% of the nodes had benign lesions, 28% carcinoma, and 12% lymphoma. The comparable figures for abdominal nodal biopsies were 63%, 33% and 4%; for intrathoracic nodes, 73%, 26% and 1%; for peripheral nodes, 56%, 29% and 15%. Detailed distribution according to specific site of nodal biopsy, histological subtypes, age, and sex of patients are presented. Statistically, age is the most important factor useful in estimating the probability of whether the lymphadenopathy is due to a benign or malignant process.
71 citations
TL;DR: Fifty‐one evaluable patients with liposarcomas were reviewed and one or more local recurrences presented in 78% of patients, with Pulmonary metastases occurring in 45%, while liver metastases occurred in 13.6%.
Abstract: Fifty-one evaluable patients with liposarcomas were reviewed. Two-thirds of the patients were referred after local recurrence. One-third with primary surgery at RPMI had local recurrence rate of 31.6%. Overall, one or more local recurrences presented in 78% of patients. Pulmonary metastases occurred in 45%, while liver metastases in 13.6%.
Most common primary sites were the lower extremity, followed by the retroperitoneal area and upper extremity.
Median survival is better for upper and lower extremities than other areas (P < 0.01). The median survival was longer in the group that received radiation after resection although the difference was not statistically significant. The high rate of local recurrences suggests the adjuvant use of radiation postoperatively when the surgical margins have not been adequate.
Sixteen patients are alive and disease-free, with 10 of them having had five years or longer follow-up.
61 citations
53 citations
TL;DR: In this article, the authors reported five additional cases of metastatic basal cell carcinoma from 1894 to 1977 and concluded that the primary mode of spread of these tumors is by the interstitial route.
Abstract: The primary mode of spread of basal cell carcinoma is by direct extension. From 1894 to June 1977, 119 cases of metastatic basal cell carcinoma were reported in the world literature. We wish to report five additional cases. It is our feeling that the spread of these tumors is by the interstitial route. It is standard teaching that the interstitial embolic spread of cancer does not occur, but these five cases give strong supporting evidence to the previously reported suggestion that this route of spread may be common. The concept has considerable implications regarding treatment of most cancers.
50 citations
TL;DR: Serum GT levels are elevated in the presence of breast carcinoma and that the enzyme elevations correlate positively with the clinical stage of disease, indicating that serum GT may be potentially useful in the detection of recurrent breast cancer and as a marker of tumor response to therapy for advanced disease.
Abstract: UDP-galactose:N-acetylglucosamine galactosyltransferase (GT) is a membrane-bound enzyme active in the biosynthesis of the carbohydrate moiety of glycoproteins and glycolipids. A soluble form of GT, present in human serum, has recently been found to be elevated in the presence of various neoplasms. In this study, GT levels were measured in randomized serum samples obtained from normal controls (group I, n = 49), patients with benign breast disease (group II, n = 46), disease controls (group III, n = 50), patients with primary breast carcinoma (group IV, n = 53), and untreated metastatic breast cancer (group V, n = 23). Although substantial serum GT elevations were observed in individual control patients with active inflammatory or metabolic diseases, the mean GT levels were significantly higher in the groups with breast carcinoma (P < 0.001, 0.001, 0.02; P < 0.001, 0.001, 0.001 for groups IV and V vs groups, 1, II, and III, respectively). Furthermore, when serum GT levels were correlated with the properative clinical stage of breast cancer, significant elevations were found in 14.3% (3/21) of stage I, 66.7% (8/12) of stage II, 78.6% (11/14) of stage III, and 96.5% (28/29) of stage IV patients. These data indicate that serum GT levels are elevated in the presence of breast carcinoma and that the enzyme elevations correlate positively with the clinical stage of disease. Serum GT may be potentially useful in the detection of recurrent breast carcinoma and as a marker of tumor response to therapy for advanced disease.
49 citations
TL;DR: Approximately 1.3% of patients with lymphoma develop obstructive jaundice secondary to lymphomatous involvement of the extrahepatic biliary system, suggesting that adjunctive nutritional support, immunologic enhancement, and stress ulcer prophylaxis may be necessary if survival is to be improved.
Abstract: Approximately 1.3% of patients with lymphoma develop obstructive jaundice secondary to lymphomatous involvement of the extrahepatic biliary system. This may occur either as an initial or as a late manifestation of disease. Clinically and radiographically the condition may mimic a variety of more common causes of obstructive jaundice. Surgical exploration may be necessary to confirm the diagnosis, but local radiotherapy would appear to be the preferred mode of treatment. Rapid progression to systemic disease occurs in the majority of patients, necessitating multidrug chemotherapy. Control of jaundice by radiotherapy is good, but long-term prognosis is poor. Supervening sepsis and gastrointestinal bleeding caused the majority of deaths, suggesting that adjunctive nutritional support, immunologic enhancement, and stress ulcer prophylaxis may be necessary if survival is to be improved.
45 citations
TL;DR: Routine measurement of the level of the urinary nucleosides would be of limited value for following the disease course in patients with breast cancer, as increasing levels of m22G and m1I occurred with both response and disease progression.
Abstract: Urinary levels of the minor nucleosides, pseudouridine (psi),N2, N2-dimethylguanosine (m22G), and 1-methylinosine (m1I), were investigated in patients with breast carcinoma. Elevated levels of psi were observed in 27/131 (20.6%) patients with metastatic disease, 1/14 (7.1%) preoperative patients, and 1/28 (3.6%) postoperative N+ patients. Elevated levels of m22G and M1I were observed, respectively, in 46/131 (35.1%) and 274131 (20.6%) patients with metastatic disease, 3/14 (21.4%) and 3/14 preoperative patients, and 6/28 (21.4%) and 2/28 (7.1%) postoperative N+ patients. There was no correlation between nucleoside levels and involvement of specific organ sites with metastatic disease, nor with chemotherapy response rate or time to treatment failure. During the treatment of metastatic disease there was a tendency for elevated pretherapy psi levels to decrease with attainment of a response and, if the levels subsequently rose to be associated with treatment failure. However, increasing levels of m22G and 71I occurred with both response and disease progression. These results suggest that routine measurement of the level of the urinary nucleosides would be of limited value for following the disease course in patients with breast cancer.
TL;DR: A ten‐year retrospective study of 328 histologically proven cases of primary carcinoma of the gallbladder between 1967 and 1976, with a two‐year minimum follow‐up, suggests extensive use of prophylactic cholecystectomy.
Abstract: A ten-year retrospective study of 328 histologically proven cases of primary carcinoma of the gallbladder between 1967 and 1976, with a two-year minimum follow-up was undertaken. The overall incidence was 2.9% of all cancer cases and 31.8% of all malignant tumours of the gastrointestinal tract. Male to female ratio was 1:2.64. The disease occurred on the average at a younger age in females (43 years) than in males (50 years). Pain and lump in the right upper abdomen were the commonest clinical features. Laboratory and radiological investigations most often confirmed the diagnosis of advanced disease. The majority (80.8%) were adenocarcinomas. In all the 42 cholecystectomized patients association of gallstones was noted, but as in the majority of cases laparotomy biopsy alone was done, no mention of gallstones was recorded. Five-year survival rate of only 1.8% suggests extensive use of prophylactic cholecystectomy.
TL;DR: Four thousand seven hundred twenty‐eight autopsies performed at the Roswell Park Memorial Institute were reviewed to determine causes of death from cancer, with some differences comparing lung lesions to hepatic lesions.
Abstract: Four thousand seven hundred twenty-eight autopsies performed at the Roswell Park Memorial Institute were reviewed to determine causes of death from cancer The duration of the disease from the date of diagnosis to death, the primary site of the tumor, a detailed description of the presence or absence of metastatic tumor at a series of sites, and an estimate of the total tumor mass were included in the evaluation Twenty-three common primary sites were selected for investigation These sites represented 99% of the total series Nine causes of death were described These were respiratory failure, infection, toxic drug reaction, hepatic failure, renal failure, shock or heart failure, adrenal gland failure, electrolyte imbalance, and central nervous system failure Some of these associations were obviuosly due to the direct destruction of the organ in question There are some differences, however, comparing lung lesions to hepatic lesions These and other factors are recited in the text
TL;DR: Clinical and pathologic findings in three further cases of Pleomorphic adenomas of the human breast, including one man, are described, indicating the importance of separating this benign entity from malignancies with stromal metaplasia.
Abstract: Pleomorphic adenomas of the human breast are histologically identical to those of salivary glands. To date, the literature reports but 15 such benign tumors, all of which occurred in women. The present paper describes clinical and pathologic findings in three further cases, including one man. Considered together, unnecessary mastectomy occurred in 44.4%, indicating the importance of separating this benign entity from malignancies with stromal metaplasia. In case of examination by frozen section, a peripheral portion, if not the entire tumor, should be submitted to the pathologist.
TL;DR: Animal data indicates that certain anesthetic agents and major surgical procedures may enhance growth of micrometastatic tumor foci and the use of immunorestorative drugs in the perioperative period has been able to reverse this phenomenon in animal tumor models.
Abstract: All therapeutic modalities used in cancer patients are associated with immunosuppression. Anesthesia and surgery represent a double-edged sword. By removal of gross tumor in many patients a restoration of general immune responses can be documented. In addition, circulating antigen or antigen-antibody complexes which block tumor-specific immune responses can be abrogated by removal of bulk tumor. However, animal data indicates that certain anesthetic agents and major surgical procedures may enhance growth of micrometastatic tumor foci. One mechanism by which this occurs might be immunosuppression. The use of immunorestorative drugs in the perioperative period has been able to reverse this phenomenon in animal tumor models.
TL;DR: It is speculated that in some cases pancreatic polypeptide oversecretion may be causative for pseudo‐Verner‐Morrison syndrome in the absence of ulcer or carcinoma in the upper gastrointestinal tract.
Abstract: Two cases of pancreatic polypeptide cell hyperplasia were obtained by operation. The first case exhibited adenocarcinoma of the stomach with metastases to the neck lymph nodes and pancreatic polypeptide hypersecretion. Pancreatic polypeptide cell hyperplasia was confirmed by the immunoperoxidase method and by the elevated level of pancreatic polypeptide in the pancreatic extracts and in the circulating blood. There was no watery diarrhea syndrome. The second case presented with persistent watery diarrhea of two and one-half year duration, and the resected pancreas contained extremely large atypical islets, exclusively composed of pancreatic polypeptide cells. It is speculated that in some cases pancreatic polypeptide oversecretion may be causative for pseudo-Verner-Morrison syndrome in the absence of ulcer of carcinoma in the upper gastrointestinal tract.
TL;DR: Serum zinc levels, serum copper levels, and the Cu/Zn ratio were evaluated in 50 patients with epidermoid cancer of the head and neck to treatment with respect to site and stage of disease.
Abstract: Serum zinc levels (SZL), serum copper levels (SCL), and the Cu/Zn ratio were evaluated in 50 patients with epidermoid cancer of the head and neck to treatment with respect to site and stage of disease. There was no significant difference in these parameters compared to healthy normal controls. We could not appreciate any diagnostic or prognostic value in these parameters in patients with head and neck cancer. There was, however, a sex-related difference for SZL in men with oral cavity and women with laryngeal lesions, and a trend toward decreasing SZL and increasing SCL and the Cu/Zn ratio with advanced stage of disease.
TL;DR: Responsiveness of experimental chemotherapy on human cancer xenografts in nude mice was directly compared with clinical response to the same chemotherapy in their donor patients, which was parallel to the corresponding clinical response in each donor patient.
Abstract: Responsiveness of experimental chemotherapy on human cancer xenografts in nude mice was directly compared with clinical response to the same chemotherapy in their donor patients. These xenografts were 1 line of rectal cancer (H-26), two lines of gastric cancer (H-08 and H-22), and 1 line of breast cancer (H-62). Experimental chemotherapies studied were single-drug FT-207 to four lines of xenografts and a combination of mitomycin C, 5-FU, and cytosine arabinoside (MFC) to a line of gastric cancer H-08. Single-drug treatment with FT-207 to H-26 resulted in remarkable retardation of the tumor growth. The comparative treatment with FT-207 suppository to the donor patient of H-26 showed appreciable response. All the other chemotherapies to three other lines (H-08, H-22, and H-62) induced no significant response, which was parallel to the corresponding clinical response in each donor patient. The sensitivity to chemotherapeutic drugs was thought to be still preserved in human cancer xenografts in nude mice.
TL;DR: A case of bilateral renal carcinoma with an uncommon solitary metastasis is presented and Therapeutic rationale is discussed.
Abstract: A case of bilateral renal carcinoma with an uncommon solitary metastasis is presented. Therapeutic rationale is discussed.
TL;DR: Morphologic and histologic factors that adversely influenced the length of disease‐free interval and survival following curative surgery included 1) primary tumor 8 cm or greater in diameter, 2) tumor extension to serosa of the stomach, and 3) low grade of differentiation of the primary tumor.
Abstract: The records of 43 patients with histologically proved primary gastric sarcoma treated at M. D. Anderson Hospital and Tumor Institute between 1945 and 1975 were reviewed. Weight loss, abdominal pain, and hematemesis or melena were the most common symptoms, and palpable epigastric mass was the most common physical sign. Ninety-five percent of the gastric tumors were leiomyosarcomas. The median survival time and the five-year survival for the 29 patients who had curative gastrectomy were 33 months and 38%, respectively. Morphologic and histologic factors that adversely influenced the length of disease-free interval and survival following curative surgery included 1) primary tumor 8 cm or greater in diameter, 2) tumor extension to serosa of the stomach, and 3) low grade of differentiation of the primary tumor. Seventy-seven percent of recurrences in patients with curative tumor resection occurred within two years of resection of the primary. Of the 17 patients with advanced disease who received chemotherapy, two (15%) had objective tumor regression of greater than 50% and survived 16 and 24 months, compared with a median survival time of eight months for patients who failed to respond. New approaches that may improve the results of treatment of gastric sarcoma are discussed.
TL;DR: A chemotherapeutic agent effective against epidermoid tumors at other sites has been effective in a case reported in the recent cancer treatment literature.
Abstract: Epidermoid cancer of the pancreas is a rare variety of this malignancy. A case is presented. It has a characteristic angiographic appearance. Though in the past it has had a prognosis similar to the more common adenocarcinoma of the pancreas, a chemotherapeutic agent effective against epidermoid tumors at other sites has been effective in a case reported in the recent cancer treatment literature.
TL;DR: A 59‐year‐old woman with disease manifestations diagnosed as mycosis fungoides, as well as findings of sarcoidosis, is reported, and reasons why granulomatous MF, likegranulomators Hodgkin disease, might have a more favorable prognosis than the usual type of MF are considered.
Abstract: We report a 59-year-old woman with disease manifestations diagnosed as mycosis fungoides (MF), as well as findings of sarcoidosis. The concurrence of these two disorders, both of which may be associated with basic immunopathogenic factors, has been reported. Histologically, the cutaneous findings of both non-caseating granulomas and an infiltrate compatible with MF in the same site leads to a discussion of granulomatous MF. Whether granulomatous MF simply represents sarcoidosis developing concomitantly with MF lymphoma or is, in fact, a distinct clinical and histologic type of MF is discussed. Reasons why granulomatous MF, like granulomators Hodgkin disease, might have a more favorable prognosis than the usual type of MF are considered.
TL;DR: Review of the literature shows that the important prognostic factors are the infiltrative nature, the extent of the tumor at the primary site, and associated syndromes like myasthenia gravis and red cell hypoplasia.
Abstract: A case of invasive thymoma with metastasis to liver and brain is presented. The incidence, sites of involvement, and the different histological types of metastatic lesions are discussed. Review of the literature shows that the important prognostic factors are the infiltrative nature, the extent of the tumor at the primary site, and associated syndromes like myasthenia gravis and red cell hypoplasia. Patients with noninvasive thymoma have excellent survival by surgery, compared to a reported low (23%) five-year survival with invasive type. The average time of survival after the appearance of metastasis is about one and one-half years.
TL;DR: The feasibility of preserving the larynx at least in younger individuals and when good nursing care is available is stressed, and the choice of the various surgical procedures is discussed and the cure rates analysed.
Abstract: A study of 78 cases of base of the tongue cancer treated surgically for control of disease at the primary site is presented. Seventy-four of these cases were radiation failures, surgery being resorted to as a salvage procedure. The choice of the various surgical procedures is discussed and the cure rates analysed. Thirty-five cases required a total glossectomy, of which twenty-six did not have removal of the larynx. The feasibility of preserving the larynx at least in younger individuals and when good nursing care is available is stressed.
TL;DR: Squamous cell carcinoma arising in a parotid adenolymphoma in a patient with no other malignancy or previous irradiation to the head and neck is demonstrated.
Abstract: Adenolymphoma of the parotid gland is a benign tumor occurring primarily in middle-aged males. Major texts of surgery and pathology state that this tumor is not malignant nor does it undergo malignant degeneration. This report demonstrates squamous cell carcinoma arising in a parotid adenolymphoma in a patient with no other malignancy or previous irradiation to the head and neck.
TL;DR: A retrospective analysis of extensive surgery with resection of retroperitoneal sarcoma and total or partial resections of adjacent organs in 15 patients is presented, finding that surgery for recurrent tumor was beneficial.
Abstract: A retrospective analysis of extensive surgery with resection of retroperitoneal sarcoma and total or partial resection of adjacent organs in 15 patients is presented. Dominating symptoms were a palpable mass (80%). The tumor was felt in all patients. In 9 of 10 patients, ultrasonography showed a solid tumor with retroperitoneal location. In 14 patients (93%) the tumor was removed, in 11 of them adjacent organs also. Five of the patients were subjected to more than one operation because of tumor recurrence. Two patients died postoperatively. Six patients are alive without tumor recurrence; and three, with recurrence 18 to 62 months after the first operation. Four patients died 5–24 months after primary operation. In seven patients (50%), the tumor recurred locally. Surgery for recurrent tumor was beneficial.
Complete surgical removal provides the most effective therapeutic approach. Routine second-look operation within a year after primary surgery may be a way to improve the results. Adjuvant cytostatic therapy could be considered.
TL;DR: A statistically higher incidence of cancer of the breast was found among the black patients in the groups aged 30–50 years and 70–80 years, as compared to the white population.
Abstract: A comparative study of breast cancer was made among black and white populations admitted to two inner-city hospitals from 1971 through 1976, inclusive. There were 306 patients in the study group of which 162 were black and 144 were white. Age, sex, color, duration of illness, different quadrants of breast involved, staging of cancer, histological diagnosis, treatment given, and incidence of recurrence were studied in each group. A statistically higher incidence of cancer of the breast was found among the black patients in the groups aged 30--50 years and 70--80 years, as compared to the white population. All other parametes studied showed no statistical differences.
TL;DR: Fine‐needle‐aspiration cytology is a suitable method to establish a correct diagnosis when there is a suspicion of recurrent disease during the follow‐up of melanoma patients and makes the method preferable to diagnostic surgical excision biopsies.
Abstract: Sixty-four patients with melanoma (28 with clinical stage I disease and 36 with clinical stages II through IV disease) were fine-needle biopsied on suspicion of recurrent melanoma. Eighty-four biopsies were aspirated percutaneously and three at exploratory laparotomy. A tumor mass was present at 81 biopsies. The remaining biopsies were taken with the guidance of liver scan or fluoroscopy. In the patients with the diagnosis of recurrent malignant melanoma the cytodiagnosis was correct in 45 patients out of 47. One patient was diagnosed as breast cancer and one as malignant mesenchymal tumor. Of 40 biopsies considered normal, three were revised to be melanoma. No false-positive diagnosis was found. The frequency of false-negative diagnosis was 6%. Fine-needle-aspiration cytology is a suitable method to establish a correct diagnosis when there is a suspicion of recurrent disease during the follow-up of melanoma patients. The high diagnostic accuracy in patients with enlarged lymph nodes is excellent and makes the method preferable to diagnostic surgical excision biopsies.
TL;DR: The findings suggest that the endocrine and metabolic milieu in women with increased weight favors autonomous growth of breast cancer, and adjuvant treatment in this group should be planned accordingly.
Abstract: Body weight as a parameter to be considered in the treatment of women with breast cancer was studied to determine any association between it and estrogen receptor protein (ERP) content. ERP was determined in 83 women with primary or metastatic breast tumors. A strong association between ERP and body weight was noted among the 62 postmenopausal women with primary and metastatic tumors. 80% of those with weight equal to or less than 150 pounds had positive ERs as opposed to only 43% of those of higher weight (P < .01). A similar assocation was found among the 56 postmenopausal women with primary breast tumors. The corresponding percentages were 81 and 47 (P < .01). There were 21 determinations of ERP among premenopausal women: 13 of 21 (61%) had positive ER as opposed to 42 of 62 (68%) in the postmenopausal group. In all 83 women combined 11 of 24 overweight women had positive ERP determinations compared with 44 of 59 (75%) with lower weight (P < .025).
TL;DR: A 30‐year‐old white male developed cutaneous patches of depigmentation which were treated with Trioxsalen ingested before daily sunbathing and a darkly pigmented lesion which appeared three weeks later on his back was widely excised and classified as a low‐grade malignancy.
Abstract: A 30-year-old white male developed cutaneous patches of depigmentation which were treated with Trioxsalen ingested before daily sunbathing. A darkly pigmented lesion which appeared three weeks later on his back was widely excised and classified as a low-grade malignancy. Although the treatment of vitiligo with plants containing photodynamically active compounds dates back as far as 1400 BC, the modern period of research began only in the 1930's leading to the development of oral psoralens, a coumarin derivative. In early tests, patients showed increased sunlight tolerance and repigmentation of vitiliginous areas. Although some patients have developed uveitis and vitiligo while being treated for melanoma, previous published reports deny any cutaneous malignancy arising during drug therapy of vitiligo. The associations between vitiligo and melanoma are discussed. The possible causative role of Trioxsalen in etiology of the case presented is discussed.