Talk:Melanoma

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This article was previously a Medicine Collaboration of the Week.

Melanoma has had a peer review by Wikipedia editors which is now archived. It may contain ideas you can use to improve this article.

Contents 1 Research 2 Move: melanoma 3 Statements for or against 4 punch biopsy apperatus 5 Suggestions for the article page 6 Does anyone know PDF - images 7 To be featured (to-do) 8 Medical advice 9 Recent edits 10 Images 11 Important update? 12 Epidemiology 13 Natural history?

[edit] Research

Would like to discuss the possibility of adding a "Research" section to melanoma or to having a separate topic "Melanoma Research". Any thoughts? --Khaj 06:27, 25 July 2006 (UTC)

---

Sunlight is a controversial cause of melanoma. Philiphughesmd 04:11, 9 December 2005 (UTC) Dr. Bernie Ackerman has written an entire book about the valueless sentinel lymph node biopsy. Philiphughesmd 04:14, 9 December 2005 (UTC)

I think it may be prudent to indicate that imiquamod and Moh's are not exactly first line or established treatments for melanoma. I've aimed to do so politely. Wide local excision remains the standard of care so the value of Moh's here is unclear. It is rarely appropirate to accept inadequate surgical resection of a cancer to minimise a scar. Will Blake 06:50, 29 May 2006 (UTC)

I have removed references to minimal deviation melanoma which is not a widely recognised subtype. Many feel it arises only when a pathologist is unwilling to commit to a benign or a malignant diagnosis. Hope no-one objects Will Blake 23:53, 29 May 2006 (UTC)

[edit] punch biopsy apperatus

I'm wondering, I've never seen the tool used for a punch biopsy. I'm thinking though, it sounds more like hole-puncher, than a small cookie-cutter. Do you think maybe that might be a better description of it?

Excision biopsies are done for melanomas. Snowman 07:44, 1 August 2006 (UTC)

Not necessarily, I work with Melanoma patients and their information on a daily basis and I've seen excisional bx's but just as if not more common are shave and punch biopsies followed by a Staged Mohs or Wide Local Excision once the diagnosis of Melanoma vs. other Nevus is confirmed. SLC1 01:49, 8 September 2006 (UTC)

[edit] Suggestions for the article page

I think that it might be worth including:

• the origins of a melanocyte and the normal melanocyte
• some benign pigmented lesions

It helps to see the difference between benign and malignant pigmented lesions, but it is not always easy. Snowman 21:19, 2 August 2006 (UTC)

• the difficultly in diagnosis in children (Spitz naevus)

the histopathology is difficult. Snowman 21:19, 2 August 2006 (UTC)

• atypical presentation

Non-pigmented forms. The ulcer that does not heal. Subungual (under a finger or toe nail). Snowman 21:19, 2 August 2006 (UTC)

• premalignant or dysplatic forms
• large pigmented birth marks

all of the above would be more appropriate on the already existing melanocyte and nevus pages.--Khaj 10:25, 1 August 2006 (UTC)

The point is, I think certain large birth marks are more likely to undergo a mitotic change. Snowman 10:58, 1 August 2006 (UTC)

• photographs from light microscopy

of what? nevi or melanoma? Be specific.--Khaj 10:25, 1 August 2006 (UTC)

Lets say; various stages from dysplastic to metastatic melanoma.

• histological tissue preparation

there already is a histology page, there is nothing in histological preparation which is purely specific to melanoma.--Khaj 10:25, 1 August 2006 (UTC)

Special stains. Snowman 10:58, 1 August 2006 (UTC)

There are some melanoma histology pictures on wikicommons which could be used. --WS 18:48, 1 August 2006 (UTC)

• biopsy with adequate excision Snowman 13:38, 31 July 2006 (UTC)

again, be specific, biopsy of what? nevi or melanomas?--Khaj 10:25, 1 August 2006 (UTC)

The article page can be more specific than the discussion page. Snowman 10:58, 1 August 2006 (UTC)

In the UK the biobsy of a suspicious lesion should be done by a hospital specialist (dermatologist or possibly a surgeon). I think that a punch biosy should never by done (or in only rarely done on a large lesion) for a suspicious pigmented lesions, as the punch biosy itself my spread the mitotic cells following which a much larger area of excision is needed. Snowman 08:59, 3 August 2006 (UTC)

They should not be done, not because of spreading cells, but because accurate determination of depth of melanoma invasion is critical for treatment decisions and prognosis and this can not be reliably determined with a punch biopsy (PMID 15748548). The only exception is when the melanoma completely fits in the punch. --WS 15:16, 3 August 2006 (UTC)

[edit] Does anyone know PDF - images

Does anyone know how to extract images from a PDF file ? There's a wealth of melanoma photos that are said to be in PD but inside this PDF. Kpjas 08:22, 4 August 2006 (UTC)

These images may have a copyright and so can not be used on the wiki. Snowman 08:36, 4 August 2006 (UTC)

[edit] To be featured (to-do)

I think as a current MCOTW, we should improve it to become FA. In my opinion, what is needed:

• more images (I start to find some)
• longer history
• more references
• more external links

NCurse _work 11:41, 7 August 2006 (UTC)

Also need link or source for British study which suggests that melanoma is more common in indoor than outdoor workers. Figma 23:52, 7 August 2006 (UTC)

I started to add new references (finished at Prevention for today) and I added organizations links + Commons link. Question: should I create a gallery for the 4 histology images in commons? Maybe a histology section should be needed. NCurse _work 15:55, 8 August 2006 (UTC)

And I sent a letter to the American Academy of Dermatology to give us images. :) NCurse _work 16:08, 8 August 2006 (UTC)

Nice pictures, but are the captions correct? Snowman 12:30, 14 August 2006 (UTC)

Most of the captions are from their DermAtlas homepage. The original source. NCurse _work 12:37, 14 August 2006 (UTC)

[edit] Medical advice

This article page seems to provide medical advice more than once. Does the wiki give medical advice? Snowman 17:52, 8 August 2006 (UTC)

Seriously no! Where did you find these? Do you mean the Prevention section's Primary part? It has references. So that I wouldn't say this is a medical advice. But tell me your opinion please. NCurse _work 18:25, 8 August 2006 (UTC)

I inclination is to avoid advice at all costs, but I am not sure what the wiki policy is?

Any mole that is irregular in color or shape should be examined by a doctor to determine if it is a malignant melanoma. This is at the beginning of the diagnosis section. It does not appear to be contraversial, but it is medical advice. Perhaps is could be rephrased to something like Moles that are irregular in color or shape are suspicious of a malignant melanoma or a premalignant melanoma. This has changed the sentence from advice to a tutorial.

The prevention section says To prevent or detect melanomas (and increase survival rates), it is recommended that the public[17]. May be better to say recommended by "name-here" in "date-here" that the public..... I feel that the exact origin of the people with relatives sentence should be clear. Perhaps the whole section should be rephrased so that is is a tutorial rather than advice. Snowman 18:30, 9 August 2006 (UTC)

You're right. I made the change that you recommended ("Moles that are irregular..."). Otherwise, yes, all of that section should be rewritten. I'll try it. Maybe we should leave Melanoma MCOTW for an other week. NCurse _work 18:50, 9 August 2006 (UTC)

Melanoma has been choosen for MCOTW, and I expect that it will become an excellent article. I think that a tutorial style would be best for a featured article. I wonder if advice is different in Australia, England, USA, Scotland or Germany. I wonder it there are websites that can be linked for the primary and secondary prevention advice. There might be one for UK. Snowman 08:22, 10 August 2006 (UTC)

Should we move it to Peer? NCurse _work 17:57, 10 August 2006 (UTC)

Peer - What is that? Snowman 17:59, 10 August 2006 (UTC)

Sorry. Peer review of course. :) NCurse _work 18:13, 10 August 2006 (UTC)

What does that involve and why will that help? Snowman 18:18, 10 August 2006 (UTC)

See Wikipedia:Peer review --WS 22:06, 10 August 2006 (UTC)

When I change MCOTW, maybe this article could get a peer review. Why will that help? When I wanted Aortic dissection to be featured, peer review showed a lot of faults in the article. It could help because much more people use Peer review than MCOTW. But we can wait with that. NCurse _work 18:21, 10 August 2006 (UTC)

Of course it is also perfectly possible to have both at the same time. --WS 22:06, 10 August 2006 (UTC)

Thank you for pointing out the Wiki Peer review page. Melanoma is especially complex area in dermatology and histopathology. Snowman 08:58, 11 August 2006 (UTC)

[edit] Recent edits

NCurse please reign in your editing. Many of your changes are unnecessary and subtract from clarity. For example, you added a reference which was already existing (at the time of this writing references 8 and 9 are THE SAME, I noticed this because I wrote/edited much of the history section ... which you are editing to its detriment, please STOP). Despite your extensive efforts I think most of you're recent flood of changes are unnecessary. Khaj 09:23, 14 August 2006 (UTC)

Please tell me what and I fix my faults. Or comment here: Wikipedia:Peer review/Melanoma. Thanks! NCurse _work 09:32, 14 August 2006 (UTC)

Believe me I don't want to ruin the article. I try to make it better. NCurse _work 09:36, 14 August 2006 (UTC)

Citing slides you found in a pdf file on the internet is not a valid citation. Find alternative citations or remove them. Khaj 14:49, 14 August 2006 (UTC)

I removed them. NCurse _work 16:07, 14 August 2006 (UTC)

I see also that you reverted my reversions, WHICH I DISCUSSED ABOVE. As someone who has worked in melanoma research for six years it is REALLY FRUSTRATING to deal with someone like you. Why is it that I must pre-discuss every change WHEN YOU APPARANTLY DO NOT? It is very obvious why professionals in the biological sciences rarely donate their expertise here. You are an obvious sufferer of editcountitis. I am so frustrated with you that I am close to saying I that I give up ... you win ... at the moment it looks like this entry on Wikipedia is destined for the "please ignore" bin when I discuss further reading materials with my students. The poor english, the failure to understand what a citation really must provide, and the general bone-headedness of non-professional ham-fisted "contributors" in particular are extremely offputting. Khaj 17:06, 14 August 2006 (UTC)

First, please calm down. See that edit, it was an anonym edit, that's why I reverted it and told him on his talk page. If you edit something, regarding you're a specialist, I'd never revert it. I can't see why you create a war, I came here to improve the article, and I don't think that every of my edits were catastrophic. I accept that you know everything better in that topic, that's why I'd never revert your edit. Maybe the problem is your wikistress. Delete any of my edit, revert anything, I'm not interested, I'd never make a war (not like you). I've been able to learn here in wiki, everybody is as important and respected as much he works. Thanks... NCurse _work 21:31, 14 August 2006 (UTC)

Your last sentence is unfortunate. If everyone is given an equal voice in every article, then the truly knowledgeable drown in seas of mediocrity. Khaj 05:51, 15 August 2006 (UTC)

Khaj, I've been commenting/reviewing/etc on the peer review page, so it's possible that your objection is more to my suggestions than to NCurse's interpretations/implementations. In particular, I pointed out the awkward first sentence of the history section, which I've copyedited slightly; feel free to review it. The original wording, "While there is little serious doubt that melanoma is not a new disease..." contains weasel words that will get nitpicked if this article eventually becomes a featured article candidate.

Right, I'm going to explain this once, and then I want it reverted back. They are not "weasel words", they are an example of precise english. When there is no evidence for something then the possibility that general consensus is wrong remains open. In the case of melanoma there is no proof whatsoever (the evidence given is only suggestive and there is NO other evidence available) that melanoma was an affliction of antiquity. The evidence provided is merely suggestive. Pair this with the knowledge that nobody knows how melanoma occurs (we only know associations, e.g. sunlight) and the field remains open that the cause of melanoma is something particular to (relatively) modern times. However, rightly or wrongly, in scientific circles there is "no serious doubt" that melanoma did exist far longer than recorded history. Therefore, as a statement of fact concerning what researchers and clinicians think, those were not weasel words ... they were a statement of the uncertainty behind a generally accepted truism. Khaj 05:51, 15 August 2006 (UTC)

I hate quoting policy at people but you might want to have a look at WP:OWN. I understand your concerns regarding the integration of "normal" scientific uncertainty, but the original wording of that particular sentence is not only weak, but grammatically awkward. What do you think of "Although melanoma is unlikely to be a new disease,..."? (Additionally, given your expertise in the subject, this and related articles could surely use more attention than this single little clause is getting.) Opabinia regalis 06:56, 15 August 2006 (UTC)

Good link, perhaps you should read it yourself! Your alternative statement "Although melanoma is unlikely to be ..." itself begs for citation, what evidence is there for it to be unlikely? My version acknowledges the lack of strong evidence - there are no citations backing up your "unlikely to be new" position, it's a deficiency we will just have to accept, all we can point to is that nowhere (therefore "no") do you find scientific (therefore "serious") arguments against (therefore "doubt") the idea that melanoma has been around for a long time. Which version (yours or mine) is therefore weakest? The perception of grammatic awkwardness is just that, your perception only, read more review papers (read some of the ones in medical fields particularly). Given my expertise in this subject it WAS my original intention to devote more time to further areas, but as I worked on first the introduction (I did the first paragraph) and then started putting together the histories, this article had the extreme misfortune of becoming an MCOW. Like flies to honey well-meaning but essentially unqualified people started hashing in a flood of whatever data they could scrape together on the subject in the misguided belief that quantity equals quality. Now this article has become a mountain of confusion (the second paragraph of the introduction is hilarious from the perspective of someone who's work revolves around pigmented cells, it reads as if humans are either white or black and fails to acknowledge the spectrum which is reality - and that is just the LANGUAGE used). Therefore, I currently restrict myself to the sections I have worked on. When the dust dies down, and when time permits, I intend to do more. But the history section is something of a test case for me, if I don't get properly reasoned arguments behind changes which are made, then I don't see the point in devoting time to the other areas. Khaj 08:11, 15 August 2006 (UTC)

It strikes me as strange that you would think "it is unlikely that..." is any more or less in need of citation than "there is no serious doubt that..." when both are essentially fudges for the same thing. Rather than arguing about the specific wording of a largely extraneous sentence, why not just start with something like "Although evidence of melanoma in antiquity is scarce, a 1960s examination of nine Peruvian Inca mummies carbon dated to be approximately 2400 years old showed apparent signs of melanoma: melanotic masses in the skin and diffuse metastases to the bones."

It's bloody frustrating to go to the trouble of carefully explaining word choice to someone who then just brushes it all off as a "fudge". What gives you, as a rank outsider, the authority to summarily dismiss an insider's viewpoint? Khaj 13:24, 16 August 2006 (UTC)

However carefully each individual word was or was not chosen, the end product is still grammatically awkward. This particular discussion is about wording, not content. Opabinia regalis 01:13, 17 August 2006 (UTC)

As for the introduction, the paragraph you object to contains three sentences, each with its own reference. The reference I was able to access explicitly made reference to increased susceptibility in white people. So if you object to such classifications, I don't think we're the people to take it up with.

But you're the people editing this article into trash! Whom else can one "take it up with"? Khaj 13:24, 16 August 2006 (UTC)

The people who wrote a paper about melanoma incidence and classified their subjects by race? Since that seems to be what you object to in that paragraph. Racial classification may not be overly useful from the perspective of figuring out what individual cells are doing, but it's certainly useful from a practical, clinical perspective. Most people classify themselves by race, so reporting statistics on that variable seems reasonable for an article directed to nonspecialists. Opabinia regalis 01:13, 17 August 2006 (UTC)

The remainder of your commentary is probably best addressed elsewhere, such as individual user talk pages or with the other MCOTW participants. From what I can tell they're a pretty organized bunch. Opabinia regalis 00:18, 16 August 2006 (UTC)

Unlike you? Is that some sort of admission? If melanoma research wasn't my livelihood I would certainly just forget about this and walk away. But you're screwing with what students think is a learning resource. Khaj 13:24, 16 August 2006 (UTC)

Did you read the following text at the bottom of the editing page: If you don't want your writing to be edited mercilessly or redistributed by others, do not submit it.? It is great to have an expert onboard here, but that won't mean that no one will edit anything you wrote anymore. We are all trying to improve this (and other) article, but there is no guarantee that every edit will actually be an improvement or is 100% accurate. This is something you will have to live with and keep in your mind when you use wikipedia as a learning resource. --WS 14:47, 16 August 2006 (UTC)

Equally, something you will have to live with is someone compelled to argue their case. I did read that part and I have asked myself whether I should just "drop it". The answer, from the viewpoint of someone who has a vested interest in the development of understanding concerning this single article, is that I can not. It is interesting that I'm arguing against edit-scorekeepers and trophy hunters on what they perceive to be a trivial matter, but until I get a reasoned argument against something I have gone to the trouble to carefully explain I'm not prepared to give ground. Khaj 01:06, 17 August 2006 (UTC)

That is why these talk pages exist and there is nothing wrong with that. Also the first response from NCurse was: Please tell me what and I fix my faults. So I would suggest ending this discussion and start a new discussion here if edits show up which you are not happy or if they are still in the article. --WS 01:21, 17 August 2006 (UTC)

[edit] Images

Incidentally, the new images are great! I didn't look in detail at the license/reproduction requirements, but if it's allowed it might be useful to simplify the captions. Casual readers will not know that what they're looking at is a "violaceous nodule". Opabinia regalis 01:00, 15 August 2006 (UTC)

I've uploaded all the four images from DermAtlas with Withpermission and Fair use in|Melanoma templates and with link to the site's disclaimer. I asked the community about that in the Village Pumb (assistance) and they said it is ok. Anyway Khaj: I still hope that we can work together. NCurse _work 07:37, 15 August 2006 (UTC)

Oh, I'm sure the licenses are fine - I was wondering if the license required duplication of the captions along with the images. The caption of Image:Superficial_spreading_melanoma_1_060619.jpg in particular is not written for non-experts. Opabinia regalis 23:57, 15 August 2006 (UTC)

[edit] Important update?

Gene trial cures 2 of cancer

Summary: Government scientists turned regular blood cells into tumor attackers that wiped out all signs of cancer in two men with advanced melanoma. The striking finding, unveiled Thursday, marks an important step in the quest for gene therapy for cancer. But the genetically altered cells didn't help 15 other melanoma victims. So scientists are trying to strengthen the shots.

[edit] Epidemiology

Why is this paragraph duplicated exactly here when it already appears in the introduction?

"Melanoma of the skin accounts for 160,000 new cases worldwide each year, and is more frequent in white men.[3] It is particularly common in white populations living in sunny climates.[11] According to the WHO Report about 48,000 deaths worldwide due to malignant melanoma are registered annually.[5]"

TimothyPilgrim 13:33, 20 October 2006 (UTC)

I removed it, left the original paragraph in the lead. NCurse _work 19:49, 27 October 2006 (UTC)

[edit] Natural history?

Dear all

I think a short section on the naural history of the malignant melanoma - in situ/invasive radial/vertical growth phase would be good - as I find people even with medical background find difficult to understand the concept. Thic could help to understand the difference between the prognosis of a thin and a thick melanoma - not just give the numbers. I was thinking to include something along these lines below:

Natural history of malignant melanoma

The malignant melanoma starts as a proliferation of melanocytes, which is limited to the dermo-epidermal junction. This is also referred as radial growth phase - the tumour cells grow alongside the junction. At this phase the tumour does not have invasive potential, and the thickness of the lesion is less than 1 mm.

When the tumour cells start to move in a different direction - vertically up into the epidermis and into the papillary dermis, the behaviour of the cells changes dramatically.

The next step in the evolution is the invasive radial growth phase, which is a confusing term, however it explains the next step in the process of the radial growth, when individual cells start to acquire invasive potential. This step is important - from this point on the melanoma is capable of making a metastasis. The Breslow depth of the lesion is usually less than 1 mm, the Clark's level is usually 2.

The following step in the process is the invasive melanoma - the vertical growth phase. The tumour attained invasive potential, which is shown by the mitotic activity of the tunour cells. The metastatic cells are getting into the bloodstreem by invasion of the lymphatics and small blood vessels. The tumour thickness is usually more than 1 mm, and the tumour involves the deeper parts of the dermis.

The host elicits an immunological reaction against the tumour, which is judged by the presence and activity of the TILs (tumour infiltrating lymphocytes). These cells sometimes completely destroy the primary tumour, this called regression, which is the latest stage of the melanoma development. In certain cases the primary tumour is completely destroyed and only the metastatic tumour is discovered.

What do you think?

best wishes, Las

Laciga 00:39, 28 November 2006 (UTC)

Seems to be a good start. But the name of the section is not the best. I'll suggest a new one. Be bold to insert the text. NCurse _work 05:29, 28 November 2006 (UTC)