P450EVALUATION OF THE REPRODUCIBILITY OF TOTAL DERMOSCOPIC SCORE OFTHE STOLZ’S ABCD RULE AS A PREOPERATIVE PREDICTOR OF MELANOMATHICKNESSPatrizia Valeri, MD, Department of Dermatology, University of L’Aquila, L’Aquila, Italy,67100 L’Aquila, Italy, Maria Concetta Fargnoli, MD, Gian Piero Lozzi, MD, Ketty Peris, MD

Several studies demonstrated the usefulness of dermoscopy in the preoperative detectionof cutaneous melanoma thickness. Three different approaches, including pattern analysis,the combination of clinical and dermoscopic criteria, and attribution of total dermoscopicscore (TDS) according to the Stolz’s ABCD rule may be used. The aim of our study wasto evaluate the reproducibility of TDS of the ABCD rule as a preoperative predictor ofmelanoma thickness, involving dermatologists with different degrees of experience indermoscopy. Dermoscopic images of 73 melanomas were examined by 7 dermatologistsclassified in two groups: experts (3) and non experts (4) in dermoscopy. The results ofthe study showed a 6.2 TDS cut-off point for the detection of melanomas with Breslowthickness � 0.75 mm with 85.7% of sensitivity, 80.0% of specificity, and 82.2% ofdiagnostic accuracy (AUC value, 0.848), when the method was applied by the experts. Agood agreement between the experts (k value, 0.66) and a poor agreement between thenon experts (k value, 0.22) were observed. In conclusion, TDS provides useful informa-tion for the preoperative assessment of melanoma thickness � 0.75 mm, as reported ina previous study. However, this method has been proved to be more accurate when it isapplied by dermatologists expert in dermoscopy.

The authors have no financial interest to disclose.

P451POSSIBLE USE OF FLAVONOIDS AS CELL GROWTH INHIBITORS IN MALIGNANTMELANOMAAda Girnita, MD, Karolinska Hospital, Stockholm, Sweden, Leonard Girnita, MD, PhD,Karolinska Hospital, Stockholm, Sweden, Magnus Axelson, MD, PhD, Karolinska HospitalDepartment of Clinical Chemistry, Stockholm, Sweden, Olle Larsson, MD, PhD, Karolin-ska Hospital, Stockholm, Sweden

Flavonoids are a group of polyphenolic compounds ubiquitously found in fruits andvegetables. They are natural estrogenic compounds chemically related to tamoxifen andhave been proposed as chemopreventive and/or curative agents in different types oftumors.

The insulin-like growth factor-1 receptor (IGF-1R) plays a pivotal role in transformation,growth and survival of malignant cells, and has emerged as a general and promising targetfor cancer treatment. IGF-1R belongs to the family of transmembrane tyrosine kinasereceptors. Genetic evidence has been presented that IGF-1R is essential for optimalgrowth in vivo and in vitro of malignant cells but not for normal cells and is involved intumor cell protection against anti-tumor therapy.

For investigating the possible use of these substances on melanoma we used someselected flavonoids and tamoxifen on five human melanoma cell lines FM55, BE, DFB,SK-Mel 28 and SK-Mel 5 in similar concentrations.

Our study shows that both some flavonoids and tamoxifen can inhibit the proliferation ofmelanoma cells by inducing apoptosis in different degrees. The effect was correlated witha decrease in phosphorylation of IGF-1R.

These data suggest that tamoxifen analogues could be useful tools in melanoma treatmentusing IGF-1R as a target.

Disclosure not available at press time.

P452CUTANEOUS MILIARY PATTERN IN METASTASIZING THIN MALIGNANT MELA-NOMAJoanna E Gach, MD, University Hospitals Coventry and Warwickshire, Coventry, England,Imtiaz Ahmed, University Hospitals Coventry and Warwickshire, Coventry, England,David Snead, University Hospitals Coventry and Warwickshire, Coventry, England, An-drew Ilchyshyn, University Hospitals Coventry and Warwickshire, Coventry, England

We report a 60 year old woman with multiple black dot-like lesions on her bodyrepresenting metastatic melanoma. Four weeks previously the patient noticed rapidlyincreasing in number small black macules on her skin and regarded them as “blackheads”before deciding to seek medical advice. Three and a half years earlier she had a non-ulcerated superficial spreading malignant melanoma arising in a pre-existing naevus. Thelesion had Breslow thickness 1 mm, Clark’s level 4 and was excised from her lower backwith 1 cm margin of clearance. There was no sign of vascular invasion or regression ofthe lesion with only a sparse lymphocytic infiltration. She had been under a regularfollow-up at 3-monthly intervals and remained well. Her other medical problems includeddiscoid cutaneous lupus with scarring alopecia which was treated with mepacrine 50 mgdaily and topical clobetasol propionate.

On examination there were multiple 1-2 mm dot-like black macules and papules on herscalp, face, neck, trunk and limbs. The rest of her clinical examination was unremarkableexcept for a 3 � 2 cm tender nodule palpable in the lower outer quadrant of her breast.The breast nodule was not detectable a week later.

Skin biopsy confirmed metastatic melanoma in the skin. Baseline investigations showedmild hypercalcaemia of 2.69 mmol/L(normal range 2.22-2.58 mmol/L), and raised alkalinephosphatase of 317iu/L (30-120 iu/L), but normal lactic dehydrogenase and serum S-100protein of 0.37 ug/L (normal � 0.20ug/L). Her chest radiograph was normal. Abdominalultrasound did not show any evidence of metastasis in her liver, pancreas or kidneys.Bone scan demonstrated an increased uptake in the skull, ribs, L2 and right femur.

Cutaneous metastasis from malignant melanoma usually present as flesh coloured papulesor nodules in the skin. Our patient presented with multiple small black cutaneous dot-likemetastasis from a primary thin melanoma on the back. The mechanism for developingmiliary cutaneous pattern of metastatic disease with widespread multiple pigmentedlesions is not known although it has been suggested that distant metastasis result fromhaematogenic seeding. It has been shown that thin melanomas which exhibit extensivespontaneous regression represent a group at higher risk of developing metastasis, par-ticularly if the primary lesion involved the torso. However, repeated examination of ourpatient’s lesion failed to show any evidence of regression.

Disclosure not available at press time.

P453PATTERN OF FIRST RECURRENCE IN MELANOMA PATIENTS AFTER RADICALLYMPH NODE DISSECTIONNir Nathansohn, MD, Chaim Sheba Medical Center, Rishon Lezion, Israel, JackobSchachter, MD, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel, HaimGutman, MD, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

Introduction: Radical lymph node dissection (RLND) is the current practice treatingmelanoma patients with isolated regional lymph node metastases. The purpose of thisstudy was to describe the pattern of the first recurrence after RLND, and to identify thefactors associated with recurrence and specifically with surgical-field recurrence.

Methods: Prospectively collected data of all melanoma patients, undergoing axillary orgroin RLND, at a tertiary referral center, by a single surgical oncologist. Chi squared test,logistic regression and Cox regression analyses were applied to identify prognosticatorfor post-RLND recurrences.

Results: RLND was performed on 148 lymph node basins (141 patients). Eighty-six axillaeand 62 groins were dissected. Median follow-up was 41 months after the RLND. Eighteenpatients (13%) had had previous “tampering” in 20 basins. “Tampering” was defined asany open intervention other than radical complete lymph basin dissection, carried outbefore the RLND that is the subject of this study. RLND was preformed prophylacticallyon 36 (24%) basins, for palpable disease in 79 (53%) basins and for positive sentinel nodein 33 (23%) basins.

74 patients (52.5%) failed after the RLND during the follow-up period: 52 patients (70%)had systemic disease, 12 patients (16%) had surgical field recurrence, 8 patients (11%) hadin-transit metastases and 2 patients (3%) had local recurrence. By multivariate analysisusing the logistic regression model, the only significant predictors of recurrence afterRLND were Breslow’s thickness �4 mm (p � 0.015), tampering (p � 0.011) and lymphnode capsular invasion (p � 0.001).

“Tampering” was the only independent prognosticator for surgical field failure: 10 out of12 patients (83.3%) who had surgical field failure had previous tampering, compared to5 out of 62 patients with other types of first failures (8.1%) (p � 0.001). This effect of“tampering” did not translate into survival difference (p � .96). Surgical field failure wasnot detected in any of the patients who underwent sentinel lymph node biopsy.

Conclusion: “Tampering” the regional basin that drains a melanoma site prior to thedefinitive surgery, significantly increases the risk of surgical-field melanoma recurrenceafter RLND. Thus, such procedures should be avoided. Sentinel node biopsy, performedunder strict surgical oncology techniques, is safe with regard to surgical field failure.

Disclosure not available at press time.

P117MARCH 2004 J AM ACAD DERMATOL