A randomized, double-blind, placebo-controlled trial assessed the efficacy and toxicity of 400 mg/day fluconazole in preventing fungal infections during the first 75 days after marrow transplantation. During prophylaxis, systemic fungal infections occurred in 10 (7%) of 152 fluconazole-treated patients compared with 26 (18%) of 148 placebo-treated patients (P =.004). There were no Candida albicans infections in fluconazole recipients compared with 18 in placebo recipients (P <.001) and no significant increase in Candida infections other than C. albicans. Fluconazole also significantly reduced the incidence of superficial fungal infections (P <.001), fungal colonization (P =.037), and empiric amphotericin B use (P =.005). The probability of survival was improved in fluconazole recipients, in whom 31 deaths occurred up to day 110 after transplantation compared with 52 deaths in placebo recipients (P =.004). No clinically significant toxicity was detected with fluconazole use. Prophylactic fluconazole was safe and significantly reduced systemic fungal infections with other benefits, including improved survival at day 110 after marrow transplantation.

In an attempt to determine whether exposure to fluorescent lights may cause an increased risk for developing melanoma, 114 patients with melanoma were compared to 228 age-matched controls. Fluorescent-light exposure, along with 10 other risk factors, was analyzed for its possible relationship to malignant melanoma. No association was found between fluorescent-light exposure and increased risk for acquiring malignant melanoma.

Mammary cancer was induced in 50-day-old Sprague-Dawley rats with either 25 mg/kg body weight of N-methyl-N-nitrosourea (MNU) or 10 mg/rat of dimethylbenz(a)anthracene (DMBA). The retinoid N-(4-hydroxyphenyl)-all-trans-retinamide (RAHA) was begun in the diet (2.0 mmol/kg diet) of MNU-induced rats at 21, 48, or 52 days of age, and at 21 or 60 days of age for DMBA-induced rats. RAHA was terminated 12-17 weeks postinduction, and the animals were sacrificed at 28 weeks postinduction. Significant inhibition of tumor incidence or multiplicity was found in only one group (rats fed RAHA beginning at 48 days of age). This was not considered sufficient evidence to conclude that short-term administration of RAHA altered mammary tumor development.

The computerized database (1955 through 1982) of the Oncology Section of the Skin and Cancer Unit of New York (NY) University Medical Center includes data on 13,878 lesions. Of these lesions, 214 were diagnosed clinically and histologically as malignant melanoma (MM). An additional 51 lesions, diagnosed clinically as other than MMs, were found histologically to be MM. Seventy-nine lesions were clinically diagnosed as MM but were found histologically to be other entities. An analysis of the clinical diagnostic accuracy showed some improvement over the three periods studied (1955 through 1963, 1964 through 1973, and 1974 through 1982). Although the diagnostic accuracy for the best period (1974 through 1982) was only 64%, the diagnosis of MM was made in 84.5% of the histologically proved cases of MM, reflecting a high degree of sensitivity.

A total of 357 white patients who had melanocytic nevi that fulfilled the clinical criteria for the "classic" atypical-mole (dysplastic-nevus) syndrome (100 or more melanocytic nevi; one or more melanocytic nevi 8 mm or larger in diameter; and, one or more melanocytic nevi with atypical features) were followed for the development of cutaneous malignant melanomas. Seventeen patients (4.8%) developed malignant melanomas during an average follow-up period of 49 months. One patient developed two malignant melanomas. Eight of the malignant melanomas detected were in situ and ten were invasive melanomas (less than 0.86 mm in Breslow thickness), implying an excellent prognosis. The number of malignant melanomas detected in these patients exceeded significantly the number expected to occur in age- and sex-matched white controls. All groups were shown to have an increased risk for the development of malignant melanomas. Total-body photographs were helpful in detecting changes in size, shape, and color that led to the diagnosis of malignant melanoma. These data support the concept that patients with this readily regionalized clinical presentation of classic atypical-mole syndrome are at an increased risk for malignant melanomas and, therefore, should be examined regularly.

The shrinkage of cutaneous surgical specimens of 199 malignant melanomas was analyzed. A formula was derived that makes it possible to calculate the in vivo (preexcision) specimen diameter from the in vitro (fixed-tissue) specimen diameter. The age of the patient was found to significantly influence specimen shrinkage and was incorporated into this shrinkage formula. The calculated in vivo specimen diameter was then used to determine the width of the in vivo surgical margins with reasonable accuracy. Thus this method permits calculation of the width of surgical margins from fixed-tissue specimens.

This is the first article in a series reviewing the extensive experience of the Oncology Section of the Skin and Cancer Unit, from 1955 through 1982, with 5755 basal cell carcinomas (BCCs) treated by curettage-electrodesiccation, surgical excision, or x-ray therapy. Recurrence rates were calculated by three methods for each of the treatment modalities: 1) by the raw recurrence rate method; 2) by the "strict" 5-year recurrence rate method; and 3) by modification of the life-table method. Our analyses show that the last method best approximates the true recurrence rate. Primary (previously untreated) BCCs had a 5-year recurrence rate of 10.6%(standard error 0.6%), and previously treated BCCs had a rate of 15.4%(standard error 1.3%)(P =.0002). The greatest risk for recurrence of treated primary BCCs occurred 1 to 4 years after therapy. It is concluded that recurrence rates of primary BCCs should be reported separately from those of previously treated BCCs and that the modified life-table method is best suited to calculate 5-year recurrence rates.

This is a study of factors associated with late recurrence (i.e. 10 or more years after definitive surgery) of cutaneous malignant melanoma (MM). Four factors were evaluated: Breslow thickness, site of the primary MM, age of the patient at initial treatment for MM, and gender. These factors were compared between two groups:(1) Stage I cases in the New York University Melanoma Cooperative Group (NYU-MCG) database that had 'early recurrence'(less than 10 years) of MM, and (2) cases in the literature with late recurrence of MM plus five new cases reported here. Compared to the group of patients with 'early recurrence' of MM, the group of patients who had late recurrence of MM were found more likely to have thinner primary melanomas (p less than 0.001), to be younger (p less than 0.001), to be female (p = 0.001), and, for females, to have the MM located on an extremity (p = 0.017). Because late recurrence does occur and because the risk of developing a new primary MM is increased in MM patients, any patient who has had a MM should be followed for life.