14
Summaries of papers
specimens examined was small, and the conclusions may have been biased by observer knowledge of the tumour type. Forty surgically excised specimens of malignant melanoma were studied. Case summaries, clinical photographs and light histological material were sent to Glasgow (R.M. and A.C.) and the histogenetic type of each tumour determined. Electron-microscopy of tissue obtained from the invasive nodule was carried out in Edinburgh (J.H. and S.Z.) so that neither worker was aware ofthe histogenetic type of tumour being examined. At least two blocks from each tumour were studied, and a minimum of thirty random photographs taken. The electron micrographs were then analysed independently in Edinburgh (J.H.) and Sheffield (S.B.), both workers still being unaware of the tumour type. Particular attention was paid to melanosomal morphology. The code was then broken and the ultrastructural features correlated with the histogenetic type. Results. Types of tumour in series: LMM, 14; SSM, 14; NM, 9; metastatic skin deposit, 3. Most tumour cells contained melanosomes which were either ellipsoidal or spheroidal. The morphology of the ellipsoidal profiles was usually similar to that of normal melanosomes. Spheroidal melanosomes were of the abortive, granular or lamellar type (Clark et al., 1972). Tumour cells of LMM contained numerous ellipsoidal melanosomes whilst those of SMM, NM and metastatic deposits contained only occasional ones. All varieties of spheroidal melanosomes were seen in each histogenetic type, though granular profiles were less common in LMM. Thus the ultrastructural appearance of LMM is reasonably characteristic, but there are no obvious differences in melanosomal morphology in the nodules of SMM, NM and metastatic deposits. These results can be explained most easily on the basis of subcellular dedifferendation due to the malignant process. REFERENCES CLARK, W.H. JR., HEGGELER, B . T . & BRETTON, R. (1972) Electron Microscope Observations of Human Cutaneous Melanomas Correlated with their Biologic Behaviour in Melanoma and Skin Cancer (Ed. by W.H.McCarthy), p. 122. Government Printer, Sydney. McGovERN, V.J., MiHM, M.C. JR., BAILLY, C , BOOTH, J . C , CLARK, W.H. JR., COCHRAN, A.J., HARDY, E.G.,
HICKS, J.D., LEVENE, A., LEWIS, M.G., LITTLE, J.H. & MILTON, G . W . (1972) The classification of malignant
melanoma and its histologic reporting. Cancer, 32, 1446. MiSHIMA, Y. & MATSUNAKA, M . (1975) Pagetoid premalignant melanosis and melanoma: differentiation from Hutchinson's melanotic freckle. Journal of Investigative Dermatology, 65, 434.
Lentigo-maligna melanoma: an ultrastructural study S.S.BLEEHEN, LISA HARTLEY AND JENNIFER SENIOR Department of Dermatology, Hallamshire Hospital and University of Sheffield
Electron microscopic studies have been carried out on multiple biopsies from eight lentigo-maligna melanomas, to determine the fine structure of the 'surround' and 'nodule' cells of this type of melanoma. The 'surround' cells ofthe centrifugal growth phase were almost invariably Type I, using the classification of Clark, Heggeler & Bretton (1972). These cells contained mainly ellipsoidal melanosomes.
Summaries of papers
15
whose internal structure was essentially normal. Auto-phagocytosis of melanosomes was common in these cells with membrane bounded aggregates of melanosomes. In addition to these melanosomal complexes there were lysosomal structures containing mitochondrial debris as well as lamellated bodies. The 'nodule' cells were mainly Type I, but melanosomal and nuclear abnormalities were more frequent than in the 'surround' cells. There were also a few more undifferentiated Type II and Type III cells to be found. These cells contained spherical melanosomes which were either abortive melanosomes containing one or two coiled melanofilaments with no cross striations or membrane bounded organelles with a granular internal matrix of varying electron density. The ultrastructural findings in lentigo-maligna melanoma sharply contrast with and differ from those of the superficial spreading (Pagetoid) and nodular types of melanoma. REFERENCE CLARK, W.H. JR., HEGGELER, B . & BRETTON, R . (1972) Electron microscopic observations of human cutaneous melanomas correlated with their biologic behaviour. In: Melanoma and Skin Cancer (Ed. by W.H.McCarthy) p. 121. V.C.N.Blight, Sydney.
Cutaneous tuberculosis of the nose with unusual clinical and histological features leading to delay in diagnosis A.P.WARIN AND E.WILSON JONES St John's Hospital for Diseases ofthe Skin, London WC2
The details of five patients will be presented, all of whom had cutaneous tuberculosis of the nose. Unusual clinical features and nonspecific histology led to a delay in the diagnosis of four of them. Case I: MrsJ.U., aged ^2years. History. When she was first seen at St John's Hospital she had had a 25-year history of atrophic rhinitis. She had had several operations to correct a deviated septum and this was followed by collapse of the septum. Ten years before presenting she started to get crusting around the nostrils. She was seen by a dermatologist who considered a diagnosis of lupus vulgaris, but histology was entirely non-specific. Some months before she presented she started to develop extension of the erythema and crusting all over the nose. The nose was red and indurated and was studded with pustules. A diagnosis of rosacea was considered and histology was consistent with this, but there was no response to 3 months of oxytetracycline. She had had pulmonary tuberculosis in 1943 and her chest X-ray showed old healed T.B. She gave a history of recurrent nodules on the calves for 20 years. These were sometimes painful and occasionally ulcerated. Investigations. Biopsy nose 1962, non-specific infiammation; Biopsy nose 1972, compatible with rosacea; Biopsy leg 1972, nodular vasculitis; Mantoux test i in 10,000 positive; Culture (1972) of biopsy material from the nose revealed a scanty growth of acid alcohol fast bacilli. Treatment. Para-aminosalicylic acid and isoniazid produced an excellent response of both her nose and her nodular vasculitic lesions. Case II: Mrs E.B. aged 66 years. History. She was first seen at St John's Hospital with a 2-year history of wasting and erythema around the nose and the tip of the nose. She had been seen by a
Summaries of papers
specimens examined was small, and the conclusions may have been biased by observer knowledge of the tumour type. Forty surgically excised specimens of malignant melanoma were studied. Case summaries, clinical photographs and light histological material were sent to Glasgow (R.M. and A.C.) and the histogenetic type of each tumour determined. Electron-microscopy of tissue obtained from the invasive nodule was carried out in Edinburgh (J.H. and S.Z.) so that neither worker was aware ofthe histogenetic type of tumour being examined. At least two blocks from each tumour were studied, and a minimum of thirty random photographs taken. The electron micrographs were then analysed independently in Edinburgh (J.H.) and Sheffield (S.B.), both workers still being unaware of the tumour type. Particular attention was paid to melanosomal morphology. The code was then broken and the ultrastructural features correlated with the histogenetic type. Results. Types of tumour in series: LMM, 14; SSM, 14; NM, 9; metastatic skin deposit, 3. Most tumour cells contained melanosomes which were either ellipsoidal or spheroidal. The morphology of the ellipsoidal profiles was usually similar to that of normal melanosomes. Spheroidal melanosomes were of the abortive, granular or lamellar type (Clark et al., 1972). Tumour cells of LMM contained numerous ellipsoidal melanosomes whilst those of SMM, NM and metastatic deposits contained only occasional ones. All varieties of spheroidal melanosomes were seen in each histogenetic type, though granular profiles were less common in LMM. Thus the ultrastructural appearance of LMM is reasonably characteristic, but there are no obvious differences in melanosomal morphology in the nodules of SMM, NM and metastatic deposits. These results can be explained most easily on the basis of subcellular dedifferendation due to the malignant process. REFERENCES CLARK, W.H. JR., HEGGELER, B . T . & BRETTON, R. (1972) Electron Microscope Observations of Human Cutaneous Melanomas Correlated with their Biologic Behaviour in Melanoma and Skin Cancer (Ed. by W.H.McCarthy), p. 122. Government Printer, Sydney. McGovERN, V.J., MiHM, M.C. JR., BAILLY, C , BOOTH, J . C , CLARK, W.H. JR., COCHRAN, A.J., HARDY, E.G.,
HICKS, J.D., LEVENE, A., LEWIS, M.G., LITTLE, J.H. & MILTON, G . W . (1972) The classification of malignant
melanoma and its histologic reporting. Cancer, 32, 1446. MiSHIMA, Y. & MATSUNAKA, M . (1975) Pagetoid premalignant melanosis and melanoma: differentiation from Hutchinson's melanotic freckle. Journal of Investigative Dermatology, 65, 434.
Lentigo-maligna melanoma: an ultrastructural study S.S.BLEEHEN, LISA HARTLEY AND JENNIFER SENIOR Department of Dermatology, Hallamshire Hospital and University of Sheffield
Electron microscopic studies have been carried out on multiple biopsies from eight lentigo-maligna melanomas, to determine the fine structure of the 'surround' and 'nodule' cells of this type of melanoma. The 'surround' cells ofthe centrifugal growth phase were almost invariably Type I, using the classification of Clark, Heggeler & Bretton (1972). These cells contained mainly ellipsoidal melanosomes.
Summaries of papers
15
whose internal structure was essentially normal. Auto-phagocytosis of melanosomes was common in these cells with membrane bounded aggregates of melanosomes. In addition to these melanosomal complexes there were lysosomal structures containing mitochondrial debris as well as lamellated bodies. The 'nodule' cells were mainly Type I, but melanosomal and nuclear abnormalities were more frequent than in the 'surround' cells. There were also a few more undifferentiated Type II and Type III cells to be found. These cells contained spherical melanosomes which were either abortive melanosomes containing one or two coiled melanofilaments with no cross striations or membrane bounded organelles with a granular internal matrix of varying electron density. The ultrastructural findings in lentigo-maligna melanoma sharply contrast with and differ from those of the superficial spreading (Pagetoid) and nodular types of melanoma. REFERENCE CLARK, W.H. JR., HEGGELER, B . & BRETTON, R . (1972) Electron microscopic observations of human cutaneous melanomas correlated with their biologic behaviour. In: Melanoma and Skin Cancer (Ed. by W.H.McCarthy) p. 121. V.C.N.Blight, Sydney.
Cutaneous tuberculosis of the nose with unusual clinical and histological features leading to delay in diagnosis A.P.WARIN AND E.WILSON JONES St John's Hospital for Diseases ofthe Skin, London WC2
The details of five patients will be presented, all of whom had cutaneous tuberculosis of the nose. Unusual clinical features and nonspecific histology led to a delay in the diagnosis of four of them. Case I: MrsJ.U., aged ^2years. History. When she was first seen at St John's Hospital she had had a 25-year history of atrophic rhinitis. She had had several operations to correct a deviated septum and this was followed by collapse of the septum. Ten years before presenting she started to get crusting around the nostrils. She was seen by a dermatologist who considered a diagnosis of lupus vulgaris, but histology was entirely non-specific. Some months before she presented she started to develop extension of the erythema and crusting all over the nose. The nose was red and indurated and was studded with pustules. A diagnosis of rosacea was considered and histology was consistent with this, but there was no response to 3 months of oxytetracycline. She had had pulmonary tuberculosis in 1943 and her chest X-ray showed old healed T.B. She gave a history of recurrent nodules on the calves for 20 years. These were sometimes painful and occasionally ulcerated. Investigations. Biopsy nose 1962, non-specific infiammation; Biopsy nose 1972, compatible with rosacea; Biopsy leg 1972, nodular vasculitis; Mantoux test i in 10,000 positive; Culture (1972) of biopsy material from the nose revealed a scanty growth of acid alcohol fast bacilli. Treatment. Para-aminosalicylic acid and isoniazid produced an excellent response of both her nose and her nodular vasculitic lesions. Case II: Mrs E.B. aged 66 years. History. She was first seen at St John's Hospital with a 2-year history of wasting and erythema around the nose and the tip of the nose. She had been seen by a
