Helen Shaw | University of Worcester (original) (raw)

Papers by Helen Shaw

American Journal of Surgery, 1995

BACKGROUND: The technique of lymphoscintigraphy may allow a more selective approach to the manage... more BACKGROUND: The technique of lymphoscintigraphy may allow a more selective approach to the management of clinically negative neck nodes among patients with cutaneous head and neck melanoma.

British Journal of Dermatology, 1983

In a case-control study, 287 women with malignant melanoma were compared with 574 age-matched con... more In a case-control study, 287 women with malignant melanoma were compared with 574 age-matched controls. Red hair colour at age 5 years was associated with a tripling of risk [relative risk (RR) = 3o], blonde hair with a 60% increase (RR=i-6) and fair skin with a doubling (RR = 2-1). Women with melanoma also reported that they tended to burn (RR = i 4) and to freckle (RR =1-9) after exposure to sunlight. Since fair skin, red hair, and the tendency to burn or freckle after exposure to sunlight all cluster in the same individuals, the extent to which each of these factors had an independent influence on susceptibility to melanoma was investigated. Hair colour, especially red hair, proved to be the major determinant, followed by skin colour.

Cancer, 1986

A comparative retrospective study of patients with primary malignant melanomas of the extremities... more A comparative retrospective study of patients with primary malignant melanomas of the extremities, Clark level IV/V and tumor thickness greater than or equal to 1.5 mm, was performed in Sydney (Australia) and Groningen (The Netherlands). The efficacy of wide local excision combined with adjuvant regional perfusion (Groningen) was compared with that of wide surgical excision only (Sydney). Patients were classified by sex and tumor location. There were only sufficient numbers of female patients with a tumor of the lower extremity available for this comparative study. All patients were stage I and none received prophylactic lymph node dissection. Age, tumor location, tumor thickness, depth of infiltration and ulceration were taken into account and the factors studied within this group were 10-year disease-free rate, 10-year survival rate, and local and regional recurrences. Women with a melanoma of the leg (excluding the foot) who had been treated by excision and adjuvant regional perfusion, had a significantly better 10-year disease-free rate (P less than 0.0005), a significantly higher 10-year survival rate (0.010 less than P less than 0.025) and significantly fewer local/regional recurrences (P less than 0.0005) than women treated by wide local excision only. For tumors of the foot, however, no significant differences in 10-year disease-free rate, 10-year survival rate or local/regional recurrences were observed after perfusion.

World Journal of Surgery, 1992

The clinical and histological features of 13 malignant melanomas in children <13 years of age in ... more The clinical and histological features of 13 malignant melanomas in children <13 years of age in New South Wales, Australia, were compared with those in a control group of children with 15 Spitz nevi, 4 of which were considered atypical, and 2 unusual compound nevocellular nevi. Six of the controls had been previously diagnosed histologically as malignant melanoma. The objective observations made by one or more histopathologists experienced in reporting melanocytic lesions, and the clinical details, mainly from the Sydney Melanoma Unit files, were entered on a detailed protocol. Evaluation was assisted by the use of SPSS-X software on a mainframe VAX computer. Six of the 13 children with malignant melanoma died with their disease. The most frequent clinical features found in the malignant melanomas were bleeding, ulceration, itching, and black or variegated color. Recent enlargement and darkening were noted in the majority of both the malignant melanomas and the Spitz nevi. Histological features favoring malignancy in this series were mitoses within 0.25 mm of the dermal margin of the melanoma, a dermal mitotic rate exceeding 2/mm2, ulceration, surface exudate, large pigment granules, and clear-cell differentiation. The median thickness of the malignant melanomas was 1.3 mm but in the 4 children who died with melanoma the median thickness was 2.9 mm. Absence of mitoses, predominance of spindle cells, and diffuse maturation favored Spitz nevus. The median thickness of the Spitz nevi was 0.7 mm. Les caractéristiques cliniques et histologiques de 13 cas de mélanome malin chez des enfants âgés de moins de 13 ans dans la région de New South Wales, Australie, ont été comparées à celles d'un groupe contrôle de 15 naevi de Spitz, dont quatre atypiques et deux de composante naevocellulaire. Six de ces lésions avaient été classées auparavant comme malignes. Les observations objectives effectuées par un ou plusieurs anatomopathologistes, expérimentés dans les lésions mélanocytiques, et les faits cliniques, recueillis à partir des dossiers de l'Unité de Soins pour Mélanome de Sydney, ont été entrées dans un protocole d'analyse détaillé. L'analyse a été effectuée avec un logiciel SPSS-X sur un ordinateur VAS. Six des 13 enfants atteints de mélanome sont morts. Les caractéristiques les plus fréquemment retrouvées étaient l'hémorragie, l'ulcération, le prurit et la couleur noire ou versicolore. Une histoire récente d'élargissement ou d'intensification de la couleur a été notée dans la majorité des mélanomes malins et des naevi de Spitz. Dans cette série, les critères de malignité ont associé des mitoses à moins de 0.25 mm de la marge dermique du mélanome, une fréquence de mitoses supérieure à 2/mm2 de derme, la présence d'ulcération, d'un exsudat de surface, de granules pigmentés larges et une différenciation de cellules claires. L'épaisseur médiane des mélanomes malins était de 1.3 mm mais, chez quatre des six enfants qui sont morts, l'épaisseur médiane était de 2.9 mm. En faveur d'un naevi de Spitz, on retenait l'absence de mitose, la prédominance de cellules fusiformes et une maturation diffuse. L'épaisseur médiane des naevi de Spitz était de 0.7 mm. Se compararon las características clínicas e histológicas de 13 melanomas malignos en niños menores de 13 años en New South Wales, Australia, con un grupo control de 15 nevus de Spitz, 4 de los cuales fueron considerados atípicos, y 2 raros nevus compuestos novocelulares. Seis de los controles habían sido histológicamente diagnosticados previamente como melanoma maligno. Las observaciones objetivas realizadas por uno o mas histopatólogos expertos en reportar lesiones melanocíticas, junto con la información clínica, principalmente emanados de los archivos de la Unidad de Melanoma de Sydney, fueron ingresados a un minucioso protocolo, y la evolución fue analizada con ayuda de computación (SPSS-X Software y computador mainframe VAX). Seis de los 13 niños con melanoma maligno murieron por causa de la enfermedad. Los signos clínicos hallados con mayor frecuencia fueron el sangrado, la ulceración, el prurito y el color negro o jaspeado. Se observó aumento del tamaño y oscurecimiento reciente de la lesión en la mayoría de los melanomas malignos y de los nevus de Spitz. Las características histológicas que favorecieron el diagnóstico de melanoma en esta serie fueron las mitosis dentro de un margen de 0.25 mm del melanoma dérmico, una tasa de mitosis dérmica superior a 2/mm2, ulceración, exudado de superfice, gránulos pigmentados grandes y diferenciación de células claras. El espesor promedio de los melanomas malignos fue 1.3 mm, pero en los 4 niños que murieron por causa del melanoma el espesor promedio fue 2.9 mm. La ausencia de mitosis, el predominio de células fusiformes y la maduración difusa fueron hallazgos que favorecieron el diagnóstico de nevus de Spitz; el espesor promedio de los nevus de Spitz fue 0.7 mm.

Cancer, 1983

and the Denartment of Sureerv. the Universitv of Svdnev. and the Mel-tients treated with melanoma... more and the Denartment of Sureerv. the Universitv of Svdnev. and the Mel-tients treated with melanoma at this institution during the past 25 years. Follow-up information is available for over 95%. There were 537 patients who presented with I ,,

Annals of Surgery, 1982

Twelve clinical and pathologic parameters were compared in two series of Stage I melanoma patient... more Twelve clinical and pathologic parameters were compared in two series of Stage I melanoma patients treated at the University of Alabama in Birmingham, USA (676 patients) and at the University of Sydney in New South Wales, Australia (1,110 patients). Actuarial survival rates were virtually the same at the two institutions over a 25-year follow-up period. The incidence of thin melanomas (<0.76 mm) was also similar at both geographic locations (25% vs. 26%). Other similarities of these two patient populations included the following: 1) tumor thickness (Breslow Microstaging), 2) level of invasion (Clark Microstaging), 3) surgical results, 4) sex distribution, and 5) age distribution. The greatest differences between the two patient populations were their 1) anatomic distribution, 2) growth pattern, and 3) incidence of ulceration. The trunk was the most common site of melanoma, and occurred more frequently among Australian patients (37% vs. 28%).

Journal of The American College of Surgeons, 1999

Background: Accurate staging of melanoma patients by sentinel node (SN) biopsy can be achieved on... more Background: Accurate staging of melanoma patients by sentinel node (SN) biopsy can be achieved only if all SNs draining a given melanoma site are identified and removed for detailed histologic examination. Lymphoscintigraphy with a radiolabeled colloid provides an objective and reliable method of locating SNs and demonstrates that confident prediction of their location is not possible on clinical grounds. Study Design: Lymphatic drainage pathways demonstrated by preoperative lymphoscintigraphy for 1,759 patients with primary cutaneous melanomas were reviewed, and locations of SNs in these patients were documented. An SN was defined as any node receiving direct lymphatic drainage from a primary melanoma site.

American Journal of Surgical Pathology, 2003

A sentinel lymph node (SLN) that is melanoma negative by pathologic examination implies absence o... more A sentinel lymph node (SLN) that is melanoma negative by pathologic examination implies absence of melanoma metastasis to that regional lymph node field. However, a small proportion of patients develop regional node field recurrence after a negative SLN biopsy. In this study, we reviewed the histopathology of negative SLNs from such patients to determine whether occult melanoma cells were present in the SLNs, to characterize the pathologic features of false-negative SLNs, and to provide recommendations for the histopathologic examination of these specimens. Between March 1992 and June 2001, of 1152 patients who had undergone SLN biopsy for primary melanomas at the Sydney Melanoma Unit, 976 were diagnosed with negative SLNs by initial pathologic examination (using 2 hematoxylin and eosin stained sections, and 2 immunostained sections for S-100 protein and HMB45), and follow-up was available in 957. Of these, 26 (2.7%) developed regional lymph node recurrence during a median follow-up period of 35.7 months. For 22 of them, the original slides and tissue blocks were available for reexamination. The original slides of each block were reviewed. Multiple further sections were cut from each block and stained with hematoxylin and eosin, for S-100, HMB45, and Melan A. Deposits of occult melanoma cells were detected in 7 of the 22 cases (31.8%). In 5 of the 7 cases, deposits of melanoma cells were present only in the recut sections. There were no significant differences in clinical and pathologic variables for those patients in whom occult melanoma cells were found by pathologic reexamination of their SLNs, compared with those in whom no melanoma cells were detected. The detection of melanoma cell deposits in only 7 of 22 false-negative SLNs suggests that mechanisms other than failure of histopathologic examination may contribute to the failure of the SLN biopsy technique in some patients. The failure rate for melanoma detection in SLNs by our routine pathologic examination, using the current protocol at our institution, was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1% (7 of 957 patients). Routinely performing more intensive histopathologic examination of SLNs is difficult to justify from a cost benefit perspective; we therefore recommend examining two hematoxylin and eosin stained sections and two immunostained sections (for S-100 and HMB45) routinely on SLNs from melanoma patients.