Report of Six Cases of Malignant Melanoma Treated with X-radiation, with Two Cases Cured for Over Five Years

MY excuse for presenting these few cases before this Society is that practically all text-books on this condition begin by a description which usually reads, “This is the most malignant of the sarcomata” (1), and terminate as to prognosis and treatment by suggesting wide excision, laying great stress upon the fact that malignant melanoma is almost invariably fatal. I have a statement from one of our best surgical authorities which supports the foregoing text-book treatment and prognosis, in which he states: “In the past thirty years we have operated upon at least two hundred malignant melanomas, with only one five-year cure” (2) . In some correspondence with this surgeon he mentioned the fact that this case had had some post-operative X-radiation, and, in reality, I fully believe that X-ray therapy really produced this one cure for him over a five-year period. So with a surgical mortality of 100 per cent in treatment of malignant melanoma, and with a five-year cure of 33 per cent by X-radiation, I felt it my duty to report these cases. I do not propose to go into a lengthy academic discussion as to where this tumor derives its coloring matter, melanin, nor from what layer of the primitive embryo it arises, nor any histologic descriptive dissertation on the subject. To those interested in these phases of the matter I would recommend that they read an article in Surgical Clinics of North America (April, 1926) by Edgar L. Gilcreest, as this article gives a plausible explanation as to the origin of the malignant melanoma. So without further ado the six cases, with a fairly detailed description of the history and treatment pertaining only to the disease under consideration, will be presented. Case 1. Mr. C., aged 60 years, sent to me in May, 1923, for radiation of a small black tumor of the skin, located one-half inch posterior to the external canthus of the left eye. This was quite an insignificant looking growth, but I can assure you that in the case of one patient who died, the primary growth was even more insignificant in appearance. The patient stated that this tumor had been on his face for a number of years and had given no trouble until two weeks previously, when it had received a bump. From that time on it had grown rapidly, increasing to twice its original size in two weeks' time. It had also begun to ulcerate, associated with slight pain and a slight serous discharge without scab formation. This tumor, along with a margin of healthy skin, was given a caustic dose of X-ray, 120 K.V., 60 milliampere-minutes, unfiltered, at approximately 10-inch T.S.D., and at the end of two months it had healed completely, with no evidence of pigmentation remaining. This patient was heard from in June of this year [1929], and has remained well. Case 2. Mr. B., aged nearly 40 years, was referred to me in May, 1924. He had a growth in the submaxillary region the size of a large English walnut.