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|00000590| 00 00 00 00 f1 6f 05 00 | 00 00 00 00 24 55 6e 69 |.....o..|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 30 32 30 30 7d |que_ID{Y|RB00200}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 53 75 62 75 6e 67 75 |..$Title|{Subungu|
|000005c0| 61 6c 20 4d 65 6c 61 6e | 6f 6d 61 20 6f 66 20 74 |al Melan|oma of t|
|000005d0| 68 65 20 48 61 6e 64 7d | 0d 0a 24 41 75 74 68 6f |he Hand}|..$Autho|
|000005e0| 72 7b 0d 0a 48 75 64 73 | 6f 6e 2c 20 44 41 0d 0a |r{..Huds|on, DA..|
|000005f0| 4b 72 69 67 65 2c 20 4a | 45 4a 0d 0a 53 74 72 6f |Krige, J|EJ..Stro|
|00000600| 76 65 72 2c 20 52 4d 0d | 0a 4b 69 6e 67 2c 20 48 |ver, RM.|.King, H|
|00000610| 53 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |S}..$Aff|iliation|
|00000620| 7b 55 6e 69 76 20 6f 66 | 20 43 61 70 65 20 54 6f |{Univ of| Cape To|
|00000630| 77 6e 3b 20 47 72 6f 6f | 74 65 20 53 63 68 75 75 |wn; Groo|te Schuu|
|00000640| 72 20 48 6f 73 70 2c 20 | 43 61 70 65 20 54 6f 77 |r Hosp, |Cape Tow|
|00000650| 6e 2c 20 53 6f 75 74 68 | 20 41 66 72 69 63 61 7d |n, South| Africa}|
|00000660| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 4a 20 48 61 6e |..$Journ|al{J Han|
|00000670| 64 20 53 75 72 67 7d 0d | 0a 24 56 6f 6c 75 6d 65 |d Surg}.|.$Volume|
|00000680| 7b 31 35 42 7d 0d 0a 24 | 50 61 67 65 7b 32 38 38 |{15B}..$|Page{288|
|00000690| 2d 32 39 30 7d 0d 0a 24 | 44 61 74 65 7b 31 39 39 |-290}..$|Date{199|
|000006a0| 30 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 39 31 20 |0}..$YBV|ol{1991 |
|000006b0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 44 65 72 |Year Boo|k of Der|
|000006c0| 6d 61 74 6f 6c 6f 67 79 | 7d 0d 0a 24 43 68 61 70 |matology|}..$Chap|
|000006d0| 74 65 72 7b 31 33 2d 34 | 33 7d 0d 0a 24 59 42 45 |ter{13-4|3}..$YBE|
|000006e0| 64 69 74 6f 72 7b 44 72 | 73 2e 20 20 53 6f 62 65 |ditor{Dr|s.  Sobe|
|000006f0| 72 20 61 6e 64 20 46 69 | 74 7a 70 61 74 72 69 63 |r and Fi|tzpatric|
|00000700| 6b 7d 0d 0a 24 54 61 62 | 6c 65 7b 54 61 62 6c 65 |k}..$Tab|le{Table|
|00000710| 20 4f 6d 69 74 74 65 64 | 7d 0d 0a 24 43 6f 6d 6d | Omitted|}..$Comm|
|00000720| 65 6e 74 61 74 6f 72 7b | 41 2e 4a 2e 20 20 53 6f |entator{|A.J.  So|
|00000730| 62 65 72 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |ber, M.D|.}....Co|
|00000740| 70 79 72 69 67 68 74 20 | 28 43 29 20 59 65 61 72 |pyright |(C) Year|
|00000750| 20 42 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 | Book Me|dical Pu|
|00000760| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 20 20 |blishers|, Inc.  |
|00000770| 31 39 39 31 0d 0a 0d 0a | 31 39 39 31 20 59 65 61 |1991....|1991 Yea|
|00000780| 72 20 42 6f 6f 6b 20 6f | 66 20 44 65 72 6d 61 74 |r Book o|f Dermat|
|00000790| 6f 6c 6f 67 79 0d 0a 0d | 0a 43 68 61 70 74 65 72 |ology...|.Chapter|
|000007a0| 20 31 33 2d 2d 4d 65 6c | 61 6e 6f 63 79 74 69 63 | 13--Mel|anocytic|
|000007b0| 20 4e 65 76 69 20 61 6e | 64 20 4d 65 6c 61 6e 6f | Nevi an|d Melano|
|000007c0| 6d 61 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ma....--|--------|
|000007d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000810| 2d 2d 2d 2d 0d 0a 53 75 | 62 75 6e 67 75 61 6c 20 |----..Su|bungual |
|00000820| 4d 65 6c 61 6e 6f 6d 61 | 20 6f 66 20 74 68 65 20 |Melanoma| of the |
|00000830| 48 61 6e 64 0d 0a 0d 0a | 48 75 64 73 6f 6e 20 44 |Hand....|Hudson D|
|00000840| 41 3b 20 4b 72 69 67 65 | 20 4a 45 4a 3b 20 53 74 |A; Krige| JEJ; St|
|00000850| 72 6f 76 65 72 20 52 4d | 3b 20 4b 69 6e 67 20 48 |rover RM|; King H|
|00000860| 53 0d 0a 28 55 6e 69 76 | 20 6f 66 20 43 61 70 65 |S..(Univ| of Cape|
|00000870| 20 54 6f 77 6e 3b 20 47 | 72 6f 6f 74 65 20 53 63 | Town; G|roote Sc|
|00000880| 68 75 75 72 20 48 6f 73 | 70 2c 20 43 61 70 65 20 |huur Hos|p, Cape |
|00000890| 54 6f 77 6e 2c 20 53 6f | 75 74 68 20 41 66 72 69 |Town, So|uth Afri|
|000008a0| 63 61 29 0d 0a 4a 20 48 | 61 6e 64 20 53 75 72 67 |ca)..J H|and Surg|
|000008b0| 20 31 35 42 3a 32 38 38 | 2d 32 39 30 2c 20 31 39 | 15B:288|-290, 19|
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|000008f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000910| 2d 2d 0d 0a 0d 0a 41 62 | 73 74 72 61 63 74 0d 0a |--....Ab|stract..|
|00000920| 0d 0a 20 20 20 20 20 53 | 75 62 75 6e 67 75 61 6c |..     S|ubungual|
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|00000950| 20 75 73 75 61 6c 6c 79 | 20 61 70 70 65 61 72 73 | usually| appears|
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|000009b0| 6d 61 74 69 63 2c 20 6f | 72 0d 0a 69 6e 66 6c 61 |matic, o|r..infla|
|000009c0| 6d 6d 61 74 6f 72 79 20 | 6c 65 73 69 6f 6e 20 28 |mmatory |lesion (|
|000009d0| 46 69 67 20 31 33 2d 36 | 29 2e 20 20 4f 6e 65 20 |Fig 13-6|).  One |
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|00000a30| 20 69 6e 20 69 74 73 20 | 63 6f 75 72 73 65 2e 20 | in its |course. |
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|00001530| 62 73 74 72 61 63 74 0d | 0a 0d 0a 20 20 20 20 20 |bstract.|...     |
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|00001e70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00001ec0| 3b 20 57 65 62 62 20 53 | 56 3b 20 43 6c 61 72 6b |; Webb S|V; Clark|
|00001ed0| 20 57 48 20 4a 72 0d 0a | 28 54 75 6c 61 6e 65 20 | WH Jr..|(Tulane |
|00001ee0| 55 6e 69 76 2c 20 4e 65 | 77 20 4f 72 6c 65 61 6e |Univ, Ne|w Orlean|
|00001ef0| 73 3b 20 55 6e 69 76 20 | 6f 66 20 50 65 6e 6e 73 |s; Univ |of Penns|
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|00001f20| 67 20 50 61 74 68 6f 6c | 20 31 34 3a 35 33 2d 36 |g Pathol| 14:53-6|
|00001f30| 38 2c 20 31 39 39 30 0d | 0a 2d 2d 2d 2d 2d 2d 2d |8, 1990.|.-------|
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|00001f50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001f70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000029d0| 42 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |Book Med|ical Pub|
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|00002a20| 31 33 2d 2d 4d 65 6c 61 | 6e 6f 63 79 74 69 63 20 |13--Mela|nocytic |
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|00002a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a60| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002a90| 2d 2d 2d 0d 0a 53 70 69 | 6e 64 6c 65 20 43 65 6c |---..Spi|ndle Cel|
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|00002b00| 72 65 74 74 20 54 4c 3b | 20 53 6b 65 6c 74 6f 6e |rett TL;| Skelton|
|00002b10| 20 48 47 20 49 49 49 3b | 20 4c 75 70 74 6f 6e 20 | HG III;| Lupton |
|00002b20| 47 50 3b 20 47 72 61 68 | 61 6d 20 4a 48 0d 0a 28 |GP; Grah|am JH..(|
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|00002b50| 57 61 73 68 69 6e 67 74 | 6f 6e 2c 20 44 43 3b 20 |Washingt|on, DC; |
|00002b60| 41 6e 61 74 6f 6d 69 63 | 20 50 61 74 68 6f 6c 6f |Anatomic| Patholo|
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|00002b80| 42 65 74 68 65 73 64 61 | 2c 20 4d 64 3b 20 53 63 |Bethesda|, Md; Sc|
|00002b90| 72 69 70 70 73 20 43 6c | 69 6e 69 63 2c 20 4c 61 |ripps Cl|inic, La|
|00002ba0| 4a 6f 6c 6c 61 2c 20 43 | 61 6c 69 66 29 0d 0a 41 |Jolla, C|alif)..A|
|00002bb0| 6d 20 4a 20 53 75 72 67 | 20 50 61 74 68 6f 6c 20 |m J Surg| Pathol |
|00002bc0| 31 33 3a 39 33 31 2d 39 | 33 39 2c 20 31 39 38 39 |13:931-9|39, 1989|
|00002bd0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00002be0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002bf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002c20| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|00002c30| 20 20 20 20 20 43 72 69 | 74 65 72 69 61 20 66 6f |     Cri|teria fo|
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|00002c90| 65 76 69 20 66 72 6f 6d | 20 6d 61 6c 69 67 6e 61 |evi from| maligna|
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|00003630| 65 6e 2c 20 50 4b 0d 0a | 50 6f 75 6c 73 65 6e 2c |en, PK..|Poulsen,|
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|000036b0| 73 70 2c 20 4f 64 65 6e | 73 65 2c 20 44 65 6e 6d |sp, Oden|se, Denm|
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|000036f0| 36 36 7d 0d 0a 24 44 61 | 74 65 7b 31 39 39 30 7d |66}..$Da|te{1990}|
|00003700| 0d 0a 24 59 42 56 6f 6c | 7b 31 39 39 31 20 59 65 |..$YBVol|{1991 Ye|
|00003710| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 44 65 72 6d 61 |ar Book |of Derma|
|00003720| 74 6f 6c 6f 67 79 7d 0d | 0a 24 43 68 61 70 74 65 |tology}.|.$Chapte|
|00003730| 72 7b 31 33 2d 34 37 7d | 0d 0a 24 59 42 45 64 69 |r{13-47}|..$YBEdi|
|00003740| 74 6f 72 7b 44 72 73 2e | 20 20 53 6f 62 65 72 20 |tor{Drs.|  Sober |
|00003750| 61 6e 64 20 46 69 74 7a | 70 61 74 72 69 63 6b 7d |and Fitz|patrick}|
|00003760| 0d 0a 24 54 61 62 6c 65 | 7b 7d 0d 0a 24 43 6f 6d |..$Table|{}..$Com|
|00003770| 6d 65 6e 74 61 74 6f 72 | 7b 41 2e 4a 2e 20 20 53 |mentator|{A.J.  S|
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|000037b0| 75 62 6c 69 73 68 65 72 | 73 2c 20 49 6e 63 2e 20 |ublisher|s, Inc. |
|000037c0| 20 31 39 39 31 0d 0a 0d | 0a 31 39 39 31 20 59 65 | 1991...|.1991 Ye|
|000037d0| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 44 65 72 6d 61 |ar Book |of Derma|
|000037e0| 74 6f 6c 6f 67 79 0d 0a | 0d 0a 43 68 61 70 74 65 |tology..|..Chapte|
|000037f0| 72 20 31 33 2d 2d 4d 65 | 6c 61 6e 6f 63 79 74 69 |r 13--Me|lanocyti|
|00003800| 63 20 4e 65 76 69 20 61 | 6e 64 20 4d 65 6c 61 6e |c Nevi a|nd Melan|
|00003810| 6f 6d 61 0d 0a 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d |oma....-|--------|
|00003820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003860| 2d 2d 2d 2d 2d 0d 0a 4d | 61 6c 69 67 6e 61 6e 74 |-----..M|alignant|
|00003870| 20 4d 65 6c 61 6e 6f 6d | 61 3a 20 20 43 68 61 6e | Melanom|a:  Chan|
|00003880| 67 69 6e 67 20 54 72 65 | 6e 64 73 20 69 6e 20 46 |ging Tre|nds in F|
|00003890| 61 63 74 6f 72 73 20 49 | 6e 66 6c 75 65 6e 63 69 |actors I|nfluenci|
|000038a0| 6e 67 20 4d 65 74 61 73 | 74 61 73 69 73 2d 46 72 |ng Metas|tasis-Fr|
|000038b0| 65 65 0d 0a 53 75 72 76 | 69 76 61 6c 20 46 72 6f |ee..Surv|ival Fro|
|000038c0| 6d 20 31 39 36 34 20 74 | 6f 20 31 39 38 32 0d 0a |m 1964 t|o 1982..|
|000038d0| 0d 0a 44 72 7a 65 77 69 | 65 63 6b 69 20 4b 54 3b |..Drzewi|ecki KT;|
|000038e0| 20 46 72 79 64 6d 61 6e | 20 48 3b 20 41 6e 64 65 | Frydman| H; Ande|
|000038f0| 72 73 65 6e 20 50 4b 3b | 20 50 6f 75 6c 73 65 6e |rsen PK;| Poulsen|
|00003900| 20 48 3b 20 4c 61 64 65 | 66 6f 67 65 64 20 43 3b | H; Lade|foged C;|
|00003910| 20 56 69 62 65 20 50 0d | 0a 28 52 69 67 73 68 6f | Vibe P.|.(Rigsho|
|00003920| 73 70 69 74 61 6c 65 74 | 2c 20 43 6f 70 65 6e 68 |spitalet|, Copenh|
|00003930| 61 67 65 6e 3b 20 55 6e | 69 76 20 6f 66 20 43 6f |agen; Un|iv of Co|
|00003940| 70 65 6e 68 61 67 65 6e | 3b 20 4e 65 77 20 59 6f |penhagen|; New Yo|
|00003950| 72 6b 20 55 6e 69 76 3b | 20 55 6e 69 76 20 48 6f |rk Univ;| Univ Ho|
|00003960| 73 70 2c 0d 0a 4f 64 65 | 6e 73 65 2c 20 44 65 6e |sp,..Ode|nse, Den|
|00003970| 6d 61 72 6b 29 0d 0a 43 | 61 6e 63 65 72 20 36 35 |mark)..C|ancer 65|
|00003980| 3a 33 36 32 2d 33 36 36 | 2c 20 31 39 39 30 0d 0a |:362-366|, 1990..|
|00003990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000039a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000039b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000039c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000039d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|000039e0| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct....  |
|000039f0| 20 20 20 54 68 65 20 69 | 6e 63 69 64 65 6e 63 65 |   The i|ncidence|
|00003a00| 20 72 61 74 65 20 6f 66 | 20 6d 61 6c 69 67 6e 61 | rate of| maligna|
|00003a10| 6e 74 20 6d 65 6c 61 6e | 6f 6d 61 20 69 73 20 69 |nt melan|oma is i|
|00003a20| 6e 63 72 65 61 73 69 6e | 67 20 66 61 73 74 65 72 |ncreasin|g faster|
|00003a30| 20 74 68 61 6e 20 74 68 | 61 74 0d 0a 6f 66 20 61 | than th|at..of a|
|00003a40| 6e 79 20 6f 74 68 65 72 | 20 6d 61 6c 69 67 6e 61 |ny other| maligna|
|00003a50| 6e 63 79 20 69 6e 20 44 | 65 6e 6d 61 72 6b 2c 20 |ncy in D|enmark, |
|00003a60| 62 75 74 20 61 74 20 74 | 68 65 20 73 61 6d 65 20 |but at t|he same |
|00003a70| 74 69 6d 65 20 74 68 65 | 20 70 72 6f 67 6e 6f 73 |time the| prognos|
|00003a80| 69 73 20 69 73 0d 0a 63 | 6f 6e 73 74 61 6e 74 6c |is is..c|onstantl|
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|00003aa0| 65 20 66 61 63 74 6f 72 | 73 20 6d 6f 73 74 20 72 |e factor|s most r|
|00003ab0| 65 73 70 6f 6e 73 69 62 | 6c 65 20 66 6f 72 20 6d |esponsib|le for m|
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|00003d40| 64 20 62 65 74 74 65 72 | 20 74 68 61 6e 20 6d 61 |d better| than ma|
|00003d50| 6c 65 73 2e 20 20 54 68 | 65 0d 0a 6d 6f 72 65 20 |les.  Th|e..more |
|00003d60| 69 6e 74 65 6e 73 65 20 | 74 68 65 20 69 6e 66 6c |intense |the infl|
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|00003db0| 72 6c 79 20 61 72 65 20 | 64 65 74 65 63 74 65 64 |rly are |detected|
|00003dc0| 20 65 61 72 6c 69 65 72 | 20 6e 6f 77 20 74 68 61 | earlier| now tha|
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|00003e20| 72 20 69 6e 66 6c 61 6d | 6d 61 74 69 6f 6e 2e 20 |r inflam|mation. |
|00003e30| 20 49 6e 20 63 6f 6e 74 | 72 61 73 74 2c 0d 0a 74 | In cont|rast,..t|
|00003e40| 68 65 20 64 69 73 74 72 | 69 62 75 74 69 6f 6e 73 |he distr|ibutions|
|00003e50| 20 6f 66 20 63 65 6c 6c | 20 74 79 70 65 20 61 6e | of cell| type an|
|00003e60| 64 20 74 75 6d 6f 72 20 | 6c 6f 63 61 74 69 6f 6e |d tumor |location|
|00003e70| 20 68 61 76 65 20 73 68 | 69 66 74 65 64 20 69 6e | have sh|ifted in|
|00003e80| 20 74 68 65 0d 0a 64 69 | 72 65 63 74 69 6f 6e 20 | the..di|rection |
|00003e90| 6f 66 20 61 20 77 6f 72 | 73 65 20 70 72 6f 67 6e |of a wor|se progn|
|00003ea0| 6f 73 69 73 2e 20 20 57 | 68 65 6e 20 70 6c 61 6e |osis.  W|hen plan|
|00003eb0| 6e 69 6e 67 20 6c 6f 6e | 67 2d 74 65 72 6d 20 63 |ning lon|g-term c|
|00003ec0| 6c 69 6e 69 63 61 6c 20 | 74 72 69 61 6c 73 2c 20 |linical |trials, |
|00003ed0| 74 68 65 0d 0a 63 68 61 | 6e 67 69 6e 67 20 64 69 |the..cha|nging di|
|00003ee0| 73 74 72 69 62 75 74 69 | 6f 6e 20 6f 66 20 70 72 |stributi|on of pr|
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|00003f00| 20 66 6f 72 20 6d 65 6c | 61 6e 6f 6d 61 20 73 68 | for mel|anoma sh|
|00003f10| 6f 75 6c 64 20 62 65 20 | 61 6e 0d 0a 69 6d 70 6f |ould be |an..impo|
|00003f20| 72 74 61 6e 74 20 63 6f | 6e 73 69 64 65 72 61 74 |rtant co|nsiderat|
|00003f30| 69 6f 6e 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |ion.....|Post-Com|
|00003f40| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 54 68 69 |ment....|     Thi|
|00003f50| 73 20 70 61 70 65 72 20 | 63 6f 6e 66 69 72 6d 73 |s paper |confirms|
|00003f60| 20 74 68 65 20 63 6c 69 | 6e 69 63 61 6c 20 69 6d | the cli|nical im|
|00003f70| 70 72 65 73 73 69 6f 6e | 20 74 68 61 74 20 69 73 |pression| that is|
|00003f80| 20 67 65 6e 65 72 61 6c | 6c 79 20 68 65 6c 64 20 | general|ly held |
|00003f90| 74 68 61 74 0d 0a 6d 65 | 6c 61 6e 6f 6d 61 73 20 |that..me|lanomas |
|00003fa0| 61 72 65 20 62 65 69 6e | 67 20 64 69 61 67 6e 6f |are bein|g diagno|
|00003fb0| 73 65 64 20 65 61 72 6c | 69 65 72 20 28 74 68 69 |sed earl|ier (thi|
|00003fc0| 6e 6e 65 72 29 2c 20 61 | 6e 64 20 74 68 61 74 20 |nner), a|nd that |
|00003fd0| 74 68 69 73 20 66 61 63 | 74 6f 72 20 69 73 0d 0a |this fac|tor is..|
|00003fe0| 73 6f 6c 65 6c 79 20 72 | 65 73 70 6f 6e 73 69 62 |solely r|esponsib|
|00003ff0| 6c 65 20 66 6f 72 20 74 | 68 65 20 69 6d 70 72 6f |le for t|he impro|
|00004000| 76 65 64 20 73 75 72 76 | 69 76 61 6c 20 61 66 74 |ved surv|ival aft|
|00004010| 65 72 20 73 75 72 67 69 | 63 61 6c 20 72 65 6d 6f |er surgi|cal remo|
|00004020| 76 61 6c 2e 20 20 54 68 | 65 0d 0a 62 65 74 74 65 |val.  Th|e..bette|
|00004030| 72 20 70 72 6f 67 6e 6f | 73 69 73 20 61 73 73 6f |r progno|sis asso|
|00004040| 63 69 61 74 65 64 20 77 | 69 74 68 20 6d 6f 72 65 |ciated w|ith more|
|00004050| 20 69 6e 74 65 6e 73 65 | 20 69 6e 66 6c 61 6d 6d | intense| inflamm|
|00004060| 61 74 6f 72 79 20 63 65 | 6c 6c 20 69 6e 66 69 6c |atory ce|ll infil|
|00004070| 74 72 61 74 65 73 0d 0a | 66 69 74 73 20 77 69 74 |trates..|fits wit|
|00004080| 68 20 74 68 65 20 6d 6f | 64 65 6c 20 57 61 6c 6c |h the mo|del Wall|
|00004090| 61 63 65 20 48 2e 20 43 | 6c 61 72 6b 2c 20 4a 72 |ace H. C|lark, Jr|
|000040a0| 2e 20 68 61 73 20 70 72 | 6f 70 6f 73 65 64 2c 20 |. has pr|oposed, |
|000040b0| 69 6e 20 77 68 69 63 68 | 20 74 68 65 20 66 69 6e |in which| the fin|
|000040c0| 64 69 6e 67 0d 0a 6f 66 | 20 61 20 62 72 69 73 6b |ding..of| a brisk|
|000040d0| 20 74 75 6d 6f 72 20 69 | 6e 66 69 6c 74 72 61 74 | tumor i|nfiltrat|
|000040e0| 69 6e 67 20 6c 79 6d 70 | 68 6f 63 79 74 69 63 20 |ing lymp|hocytic |
|000040f0| 72 65 73 70 6f 6e 73 65 | 20 73 69 67 6e 69 66 69 |response| signifi|
|00004100| 63 61 6e 74 6c 79 20 69 | 6d 70 72 6f 76 65 73 0d |cantly i|mproves.|
|00004110| 0a 73 75 72 76 69 76 61 | 6c 20 69 6e 20 70 61 74 |.surviva|l in pat|
|00004120| 69 65 6e 74 73 20 77 69 | 74 68 20 76 65 72 74 69 |ients wi|th verti|
|00004130| 63 61 6c 2d 67 72 6f 77 | 74 68 2d 70 68 61 73 65 |cal-grow|th-phase|
|00004140| 20 6d 65 6c 61 6e 6f 6d | 61 20 28 73 65 65 20 41 | melanom|a (see A|
|00004150| 62 73 74 72 61 63 74 0d | 0a 31 33 2d 34 39 29 2e |bstract.|.13-49).|
|00004160| 2d 2d 41 2e 4a 2e 20 53 | 6f 62 65 72 2c 20 4d 2e |--A.J. S|ober, M.|
|00004170| 44 2e 0d 0a 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |D...$Uni|que_ID{Y|
|00004180| 52 42 30 30 32 30 35 7d | 0d 0a 24 54 69 74 6c 65 |RB00205}|..$Title|
|00004190| 7b 4d 65 6c 61 6e 6f 6d | 61 20 4d 6f 72 74 61 6c |{Melanom|a Mortal|
|000041a0| 69 74 79 20 69 6e 20 53 | 77 69 74 7a 65 72 6c 61 |ity in S|witzerla|
|000041b0| 6e 64 20 31 39 37 30 2d | 31 39 38 36 7d 0d 0a 24 |nd 1970-|1986}..$|
|000041c0| 41 75 74 68 6f 72 7b 0d | 0a 41 6e 67 73 74 2c 20 |Author{.|.Angst, |
|000041d0| 45 0d 0a 42 69 73 69 67 | 2c 20 42 0d 0a 54 73 63 |E..Bisig|, B..Tsc|
|000041e0| 68 6f 70 70 2c 20 41 0d | 0a 53 69 67 67 2c 20 43 |hopp, A.|.Sigg, C|
|000041f0| 0d 0a 53 63 68 75 6c 65 | 72 2c 20 47 0d 0a 47 75 |..Schule|r, G..Gu|
|00004200| 74 7a 77 69 6c 6c 65 72 | 2c 20 46 0d 0a 53 63 68 |tzwiller|, F..Sch|
|00004210| 6e 79 64 65 72 2c 20 55 | 57 7d 0d 0a 24 41 66 66 |nyder, U|W}..$Aff|
|00004220| 69 6c 69 61 74 69 6f 6e | 7b 55 6e 69 76 20 5a 75 |iliation|{Univ Zu|
|00004230| 72 69 63 68 3b 20 55 6e | 69 76 65 72 73 69 74 61 |rich; Un|iversita|
|00004240| 74 73 73 70 69 74 61 6c | 20 5a 75 72 69 63 68 7d |tsspital| Zurich}|
|00004250| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 53 63 68 77 65 |..$Journ|al{Schwe|
|00004260| 69 7a 20 4d 65 64 20 57 | 6f 63 68 65 6e 73 63 68 |iz Med W|ochensch|
|00004270| 72 7d 0d 0a 24 56 6f 6c | 75 6d 65 7b 31 31 39 7d |r}..$Vol|ume{119}|
|00004280| 0d 0a 24 50 61 67 65 7b | 31 35 39 31 2d 31 35 39 |..$Page{|1591-159|
|00004290| 38 7d 0d 0a 24 44 61 74 | 65 7b 31 39 38 39 7d 0d |8}..$Dat|e{1989}.|
|000042a0| 0a 24 59 42 56 6f 6c 7b | 31 39 39 31 20 59 65 61 |.$YBVol{|1991 Yea|
|000042b0| 72 20 42 6f 6f 6b 20 6f | 66 20 44 65 72 6d 61 74 |r Book o|f Dermat|
|000042c0| 6f 6c 6f 67 79 7d 0d 0a | 24 43 68 61 70 74 65 72 |ology}..|$Chapter|
|000042d0| 7b 31 33 2d 34 38 7d 0d | 0a 24 59 42 45 64 69 74 |{13-48}.|.$YBEdit|
|000042e0| 6f 72 7b 44 72 73 2e 20 | 20 53 6f 62 65 72 20 61 |or{Drs. | Sober a|
|000042f0| 6e 64 20 46 69 74 7a 70 | 61 74 72 69 63 6b 7d 0d |nd Fitzp|atrick}.|
|00004300| 0a 24 54 61 62 6c 65 7b | 7d 0d 0a 24 43 6f 6d 6d |.$Table{|}..$Comm|
|00004310| 65 6e 74 61 74 6f 72 7b | 41 2e 4a 2e 20 20 53 6f |entator{|A.J.  So|
|00004320| 62 65 72 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |ber, M.D|.}....Co|
|00004330| 70 79 72 69 67 68 74 20 | 28 43 29 20 59 65 61 72 |pyright |(C) Year|
|00004340| 20 42 6f 6f 6b 20 4d 65 | 64 69 63 61 6c 20 50 75 | Book Me|dical Pu|
|00004350| 62 6c 69 73 68 65 72 73 | 2c 20 49 6e 63 2e 20 20 |blishers|, Inc.  |
|00004360| 31 39 39 31 0d 0a 0d 0a | 31 39 39 31 20 59 65 61 |1991....|1991 Yea|
|00004370| 72 20 42 6f 6f 6b 20 6f | 66 20 44 65 72 6d 61 74 |r Book o|f Dermat|
|00004380| 6f 6c 6f 67 79 0d 0a 0d | 0a 43 68 61 70 74 65 72 |ology...|.Chapter|
|00004390| 20 31 33 2d 2d 4d 65 6c | 61 6e 6f 63 79 74 69 63 | 13--Mel|anocytic|
|000043a0| 20 4e 65 76 69 20 61 6e | 64 20 4d 65 6c 61 6e 6f | Nevi an|d Melano|
|000043b0| 6d 61 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ma....--|--------|
|000043c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000043d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000043e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000043f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004400| 2d 2d 2d 2d 0d 0a 4d 65 | 6c 61 6e 6f 6d 61 20 4d |----..Me|lanoma M|
|00004410| 6f 72 74 61 6c 69 74 79 | 20 69 6e 20 53 77 69 74 |ortality| in Swit|
|00004420| 7a 65 72 6c 61 6e 64 20 | 31 39 37 30 2d 31 39 38 |zerland |1970-198|
|00004430| 36 0d 0a 0d 0a 41 6e 67 | 73 74 20 45 3b 20 42 69 |6....Ang|st E; Bi|
|00004440| 73 69 67 20 42 3b 20 54 | 73 63 68 6f 70 70 20 41 |sig B; T|schopp A|
|00004450| 3b 20 53 69 67 67 20 43 | 3b 20 53 63 68 75 6c 65 |; Sigg C|; Schule|
|00004460| 72 20 47 3b 20 47 75 74 | 7a 77 69 6c 6c 65 72 20 |r G; Gut|zwiller |
|00004470| 46 3b 20 53 63 68 6e 79 | 64 65 72 20 55 57 0d 0a |F; Schny|der UW..|
|00004480| 28 55 6e 69 76 20 5a 75 | 72 69 63 68 3b 20 55 6e |(Univ Zu|rich; Un|
|00004490| 69 76 65 72 73 69 74 61 | 74 73 73 70 69 74 61 6c |iversita|tsspital|
|000044a0| 20 5a 75 72 69 63 68 29 | 0d 0a 53 63 68 77 65 69 | Zurich)|..Schwei|
|000044b0| 7a 20 4d 65 64 20 57 6f | 63 68 65 6e 73 63 68 72 |z Med Wo|chenschr|
|000044c0| 20 31 31 39 3a 31 35 39 | 31 2d 31 35 39 38 2c 20 | 119:159|1-1598, |
|000044d0| 31 39 38 39 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |1989..--|--------|
|000044e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004520| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00004530| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 53 63 61 |....    | The Sca|
|00004540| 6e 64 69 6e 61 76 69 61 | 6e 20 63 6f 75 6e 74 72 |ndinavia|n countr|
|00004550| 69 65 73 20 68 61 76 65 | 20 74 68 65 20 68 69 67 |ies have| the hig|
|00004560| 68 65 73 74 20 6d 6f 72 | 74 61 6c 69 74 79 20 66 |hest mor|tality f|
|00004570| 72 6f 6d 20 6d 61 6c 69 | 67 6e 61 6e 74 0d 0a 6d |rom mali|gnant..m|
|00004580| 65 6c 61 6e 6f 6d 61 20 | 69 6e 20 45 75 72 6f 70 |elanoma |in Europ|
|00004590| 65 2c 20 61 6e 64 20 41 | 75 73 74 72 61 6c 69 61 |e, and A|ustralia|
|000045a0| 20 61 6e 64 20 4e 65 77 | 20 5a 65 61 6c 61 6e 64 | and New| Zealand|
|000045b0| 20 68 61 76 65 20 74 68 | 65 20 68 69 67 68 65 73 | have th|e highes|
|000045c0| 74 20 6d 61 6c 69 67 6e | 61 6e 74 0d 0a 6d 65 6c |t malign|ant..mel|
|000045d0| 61 6e 6f 6d 61 20 6d 6f | 72 74 61 6c 69 74 79 20 |anoma mo|rtality |
|000045e0| 72 61 74 65 73 20 69 6e | 20 74 68 65 20 77 6f 72 |rates in| the wor|
|000045f0| 6c 64 2e 20 20 41 6c 74 | 68 6f 75 67 68 20 53 77 |ld.  Alt|hough Sw|
|00004600| 69 74 7a 65 72 6c 61 6e | 64 20 68 61 73 20 74 68 |itzerlan|d has th|
|00004610| 65 20 68 69 67 68 65 73 | 74 0d 0a 6d 61 6c 69 67 |e highes|t..malig|
|00004620| 6e 61 6e 74 20 6d 65 6c | 61 6e 6f 6d 61 20 6d 6f |nant mel|anoma mo|
|00004630| 72 74 61 6c 69 74 79 20 | 72 61 74 65 20 69 6e 20 |rtality |rate in |
|00004640| 63 65 6e 74 72 61 6c 20 | 45 75 72 6f 70 65 2c 20 |central |Europe, |
|00004650| 6d 6f 72 74 61 6c 69 74 | 79 20 74 72 65 6e 64 73 |mortalit|y trends|
|00004660| 20 66 6f 72 0d 0a 6d 61 | 6c 69 67 6e 61 6e 74 20 | for..ma|lignant |
|00004670| 6d 65 6c 61 6e 6f 6d 61 | 20 68 61 76 65 20 6e 65 |melanoma| have ne|
|00004680| 76 65 72 20 62 65 65 6e | 20 73 74 75 64 69 65 64 |ver been| studied|
|00004690| 2e 20 20 43 61 6e 63 65 | 72 20 6d 6f 72 74 61 6c |.  Cance|r mortal|
|000046a0| 69 74 79 20 64 61 74 61 | 20 69 6e 0d 0a 53 77 69 |ity data| in..Swi|
|000046b0| 74 7a 65 72 6c 61 6e 64 | 20 66 6f 72 20 31 39 35 |tzerland| for 195|
|000046c0| 30 2d 31 39 38 34 20 6c | 69 73 74 20 61 6c 6c 20 |0-1984 l|ist all |
|000046d0| 64 65 61 74 68 73 20 66 | 72 6f 6d 20 73 6b 69 6e |deaths f|rom skin|
|000046e0| 20 63 61 6e 63 65 72 20 | 75 6e 64 65 72 20 61 20 | cancer |under a |
|000046f0| 73 69 6e 67 6c 65 0d 0a | 68 65 61 64 69 6e 67 20 |single..|heading |
|00004700| 61 6e 64 20 6d 61 6c 69 | 67 6e 61 6e 74 20 6d 65 |and mali|gnant me|
|00004710| 6c 61 6e 6f 6d 61 20 77 | 61 73 20 6e 6f 74 20 63 |lanoma w|as not c|
|00004720| 6f 64 65 64 20 61 73 20 | 61 20 73 65 70 61 72 61 |oded as |a separa|
|00004730| 74 65 20 65 6e 74 69 74 | 79 20 75 6e 74 69 6c 20 |te entit|y until |
|00004740| 31 39 36 39 2e 0d 0a 54 | 68 65 20 66 65 77 20 61 |1969...T|he few a|
|00004750| 76 61 69 6c 61 62 6c 65 | 20 73 74 75 64 69 65 73 |vailable| studies|
|00004760| 20 6f 66 20 6d 61 6c 69 | 67 6e 61 6e 74 20 6d 65 | of mali|gnant me|
|00004770| 6c 61 6e 6f 6d 61 20 6d | 6f 72 74 61 6c 69 74 79 |lanoma m|ortality|
|00004780| 20 69 6e 20 53 77 69 74 | 7a 65 72 6c 61 6e 64 20 | in Swit|zerland |
|00004790| 61 6c 6c 0d 0a 77 65 72 | 65 20 62 61 73 65 64 20 |all..wer|e based |
|000047a0| 6f 6e 20 72 61 77 20 64 | 65 61 74 68 20 72 61 74 |on raw d|eath rat|
|000047b0| 65 73 20 77 69 74 68 6f | 75 74 20 61 64 6a 75 73 |es witho|ut adjus|
|000047c0| 74 69 6e 67 20 66 6f 72 | 20 61 67 65 20 6f 72 20 |ting for| age or |
|000047d0| 61 67 69 6e 67 20 74 72 | 65 6e 64 73 20 69 6e 20 |aging tr|ends in |
|000047e0| 74 68 65 0d 0a 70 6f 70 | 75 6c 61 74 69 6f 6e 2e |the..pop|ulation.|
|000047f0| 20 20 41 20 72 65 74 72 | 6f 73 70 65 63 74 69 76 |  A retr|ospectiv|
|00004800| 65 20 73 74 75 64 79 20 | 77 61 73 20 64 6f 6e 65 |e study |was done|
|00004810| 20 74 6f 20 64 65 74 65 | 72 6d 69 6e 65 20 74 72 | to dete|rmine tr|
|00004820| 65 6e 64 73 20 69 6e 20 | 6d 6f 72 74 61 6c 69 74 |ends in |mortalit|
|00004830| 79 0d 0a 66 72 6f 6d 20 | 6d 61 6c 69 67 6e 61 6e |y..from |malignan|
|00004840| 74 20 6d 65 6c 61 6e 6f | 6d 61 20 69 6e 20 53 77 |t melano|ma in Sw|
|00004850| 69 74 7a 65 72 6c 61 6e | 64 2c 20 75 73 69 6e 67 |itzerlan|d, using|
|00004860| 20 64 61 74 61 20 73 74 | 61 6e 64 61 72 64 69 7a | data st|andardiz|
|00004870| 65 64 20 66 6f 72 20 61 | 67 65 20 61 6e 64 0d 0a |ed for a|ge and..|
|00004880| 61 64 6a 75 73 74 65 64 | 20 66 6f 72 20 61 67 69 |adjusted| for agi|
|00004890| 6e 67 20 74 72 65 6e 64 | 73 2e 0d 0a 20 20 20 20 |ng trend|s...    |
|000048a0| 20 49 6e 20 31 39 37 30 | 2d 31 39 38 36 2c 20 6d | In 1970|-1986, m|
|000048b0| 6f 72 74 61 6c 69 74 79 | 20 66 72 6f 6d 20 6d 61 |ortality| from ma|
|000048c0| 6c 69 67 6e 61 6e 74 20 | 6d 65 6c 61 6e 6f 6d 61 |lignant |melanoma|
|000048d0| 20 67 72 61 64 75 61 6c | 6c 79 20 69 6e 63 72 65 | gradual|ly incre|
|000048e0| 61 73 65 64 2e 0d 0a 4d | 6f 72 74 61 6c 69 74 79 |ased...M|ortality|
|000048f0| 20 66 6f 72 20 6d 65 6e | 20 69 6e 63 72 65 61 73 | for men| increas|
|00004900| 65 64 20 66 72 6f 6d 20 | 32 2e 33 36 20 70 65 72 |ed from |2.36 per|
|00004910| 20 31 30 30 2c 30 30 30 | 20 69 6e 20 31 39 37 30 | 100,000| in 1970|
|00004920| 20 74 6f 20 33 2e 33 31 | 20 69 6e 20 31 39 38 36 | to 3.31| in 1986|
|00004930| 2c 20 61 6e 64 0d 0a 66 | 6f 72 20 77 6f 6d 65 6e |, and..f|or women|
|00004940| 20 66 72 6f 6d 20 31 2e | 37 39 20 69 6e 20 31 39 | from 1.|79 in 19|
|00004950| 37 30 20 74 6f 20 32 2e | 36 31 20 69 6e 20 31 39 |70 to 2.|61 in 19|
|00004960| 38 36 2e 20 20 54 68 65 | 20 64 69 66 66 65 72 65 |86.  The| differe|
|00004970| 6e 63 65 20 69 73 20 73 | 74 61 74 69 73 74 69 63 |nce is s|tatistic|
|00004980| 61 6c 6c 79 0d 0a 73 69 | 67 6e 69 66 69 63 61 6e |ally..si|gnifican|
|00004990| 74 20 66 6f 72 20 62 6f | 74 68 20 6d 65 6e 20 61 |t for bo|th men a|
|000049a0| 6e 64 20 77 6f 6d 65 6e | 2e 20 20 57 68 65 6e 20 |nd women|.  When |
|000049b0| 63 6f 6d 70 61 72 69 6e | 67 20 6d 65 61 6e 20 35 |comparin|g mean 5|
|000049c0| 2d 79 65 61 72 20 6d 6f | 72 74 61 6c 69 74 79 0d |-year mo|rtality.|
|000049d0| 0a 72 61 74 65 73 20 66 | 6f 72 20 31 39 37 30 2d |.rates f|or 1970-|
|000049e0| 31 39 37 34 20 61 6e 64 | 20 66 6f 72 20 31 39 38 |1974 and| for 198|
|000049f0| 32 2d 31 39 38 36 2c 20 | 74 6f 74 61 6c 20 6d 6f |2-1986, |total mo|
|00004a00| 72 74 61 6c 69 74 79 20 | 66 72 6f 6d 20 6d 61 6c |rtality |from mal|
|00004a10| 69 67 6e 61 6e 74 20 6d | 65 6c 61 6e 6f 6d 61 0d |ignant m|elanoma.|
|00004a20| 0a 69 6e 63 72 65 61 73 | 65 64 20 62 79 20 32 36 |.increas|ed by 26|
|00004a30| 25 20 66 6f 72 20 6d 65 | 6e 20 61 6e 64 20 62 79 |% for me|n and by|
|00004a40| 20 32 30 25 20 66 6f 72 | 20 77 6f 6d 65 6e 2e 20 | 20% for| women. |
|00004a50| 20 57 68 65 6e 20 63 6f | 6d 70 61 72 69 6e 67 20 | When co|mparing |
|00004a60| 35 2d 79 65 61 72 0d 0a | 6d 6f 72 74 61 6c 69 74 |5-year..|mortalit|
|00004a70| 79 20 72 61 74 65 73 20 | 66 6f 72 20 70 65 72 73 |y rates |for pers|
|00004a80| 6f 6e 73 20 61 67 65 64 | 20 33 30 2d 36 34 20 79 |ons aged| 30-64 y|
|00004a90| 65 61 72 73 20 61 6e 64 | 20 74 68 6f 73 65 20 61 |ears and| those a|
|00004aa0| 67 65 64 20 6f 6c 64 65 | 72 20 74 68 61 6e 20 36 |ged olde|r than 6|
|00004ab0| 34 0d 0a 79 65 61 72 73 | 2c 20 74 68 65 72 65 20 |4..years|, there |
|00004ac0| 77 61 73 20 61 20 73 69 | 67 6e 69 66 69 63 61 6e |was a si|gnifican|
|00004ad0| 74 20 69 6e 63 72 65 61 | 73 65 20 69 6e 20 6d 6f |t increa|se in mo|
|00004ae0| 72 74 61 6c 69 74 79 20 | 61 6d 6f 6e 67 20 74 68 |rtality |among th|
|00004af0| 6f 73 65 20 6f 6c 64 65 | 72 20 74 68 61 6e 20 36 |ose olde|r than 6|
|00004b00| 34 0d 0a 79 65 61 72 73 | 2c 20 77 68 65 72 65 61 |4..years|, wherea|
|00004b10| 73 20 69 6e 20 74 68 65 | 20 79 6f 75 6e 67 65 72 |s in the| younger|
|00004b20| 20 61 67 65 20 67 72 6f | 75 70 20 74 68 65 72 65 | age gro|up there|
|00004b30| 20 77 61 73 20 6e 6f 20 | 73 69 67 6e 69 66 69 63 | was no |signific|
|00004b40| 61 6e 74 20 69 6e 63 72 | 65 61 73 65 20 69 6e 0d |ant incr|ease in.|
|00004b50| 0a 6d 6f 72 74 61 6c 69 | 74 79 2e 20 20 4d 6f 72 |.mortali|ty.  Mor|
|00004b60| 74 61 6c 69 74 79 20 66 | 72 6f 6d 20 6d 61 6c 69 |tality f|rom mali|
|00004b70| 67 6e 61 6e 74 20 6d 65 | 6c 61 6e 6f 6d 61 20 66 |gnant me|lanoma f|
|00004b80| 6f 72 20 6d 65 6e 20 61 | 67 65 64 20 6f 6c 64 65 |or men a|ged olde|
|00004b90| 72 20 74 68 61 6e 20 36 | 34 20 79 65 61 72 73 0d |r than 6|4 years.|
|00004ba0| 0a 69 6e 63 72 65 61 73 | 65 64 20 66 72 6f 6d 20 |.increas|ed from |
|00004bb0| 38 2e 31 32 20 69 6e 20 | 31 39 37 30 20 74 6f 20 |8.12 in |1970 to |
|00004bc0| 31 36 2e 38 39 20 69 6e | 20 31 39 38 36 2c 20 61 |16.89 in| 1986, a|
|00004bd0| 6e 64 20 66 6f 72 20 77 | 6f 6d 65 6e 20 61 67 65 |nd for w|omen age|
|00004be0| 64 20 6f 6c 64 65 72 20 | 74 68 61 6e 20 36 34 0d |d older |than 64.|
|00004bf0| 0a 79 65 61 72 73 20 66 | 72 6f 6d 20 33 2e 36 30 |.years f|rom 3.60|
|00004c00| 20 69 6e 20 31 39 37 30 | 20 74 6f 20 38 2e 37 36 | in 1970| to 8.76|
|00004c10| 20 69 6e 20 31 39 38 36 | 2e 20 20 54 68 65 20 6d | in 1986|.  The m|
|00004c20| 61 72 6b 65 64 20 69 6e | 63 72 65 61 73 65 20 69 |arked in|crease i|
|00004c30| 6e 20 6d 61 6c 69 67 6e | 61 6e 74 0d 0a 6d 65 6c |n malign|ant..mel|
|00004c40| 61 6e 6f 6d 61 20 6d 6f | 72 74 61 6c 69 74 79 20 |anoma mo|rtality |
|00004c50| 69 6e 20 70 65 72 73 6f | 6e 73 20 61 67 65 64 20 |in perso|ns aged |
|00004c60| 6f 6c 64 65 72 20 74 68 | 61 6e 20 36 34 20 79 65 |older th|an 64 ye|
|00004c70| 61 72 73 20 68 61 64 20 | 6e 6f 74 20 70 72 65 76 |ars had |not prev|
|00004c80| 69 6f 75 73 6c 79 20 62 | 65 65 6e 0d 0a 72 65 63 |iously b|een..rec|
|00004c90| 6f 67 6e 69 7a 65 64 2e | 20 20 54 68 75 73 2c 20 |ognized.|  Thus, |
|00004ca0| 61 67 65 20 69 73 20 61 | 6e 20 69 6e 64 65 70 65 |age is a|n indepe|
|00004cb0| 6e 64 65 6e 74 20 72 69 | 73 6b 20 66 61 63 74 6f |ndent ri|sk facto|
|00004cc0| 72 20 66 6f 72 20 64 65 | 61 74 68 20 66 72 6f 6d |r for de|ath from|
|00004cd0| 20 6d 61 6c 69 67 6e 61 | 6e 74 0d 0a 6d 65 6c 61 | maligna|nt..mela|
|00004ce0| 6e 6f 6d 61 2e 20 20 48 | 6f 77 65 76 65 72 2c 20 |noma.  H|owever, |
|00004cf0| 74 75 6d 6f 72 20 73 74 | 61 67 65 20 61 74 20 64 |tumor st|age at d|
|00004d00| 69 61 67 6e 6f 73 69 73 | 20 61 6c 73 6f 20 72 65 |iagnosis| also re|
|00004d10| 6d 61 69 6e 73 20 61 6e | 20 69 6d 70 6f 72 74 61 |mains an| importa|
|00004d20| 6e 74 0d 0a 70 72 6f 67 | 6e 6f 73 74 69 63 20 66 |nt..prog|nostic f|
|00004d30| 61 63 74 6f 72 2e 20 20 | 54 68 65 20 73 69 67 6e |actor.  |The sign|
|00004d40| 69 66 69 63 61 6e 63 65 | 20 6f 66 20 6f 74 68 65 |ificance| of othe|
|00004d50| 72 20 72 69 73 6b 20 66 | 61 63 74 6f 72 73 20 73 |r risk f|actors s|
|00004d60| 75 63 68 20 61 73 20 74 | 79 70 65 20 61 6e 64 0d |uch as t|ype and.|
|00004d70| 0a 64 75 72 61 74 69 6f | 6e 20 6f 66 20 73 75 6e |.duratio|n of sun|
|00004d80| 20 65 78 70 6f 73 75 72 | 65 20 69 6e 20 74 68 65 | exposur|e in the|
|00004d90| 20 65 6c 64 65 72 6c 79 | 20 70 6f 70 75 6c 61 74 | elderly| populat|
|00004da0| 69 6f 6e 20 77 61 73 20 | 6e 6f 74 20 63 6c 65 61 |ion was |not clea|
|00004db0| 72 2e 20 20 54 68 65 20 | 74 72 65 6e 64 0d 0a 6f |r.  The |trend..o|
|00004dc0| 66 20 69 6e 63 72 65 61 | 73 65 64 20 6d 6f 72 74 |f increa|sed mort|
|00004dd0| 61 6c 69 74 79 20 66 72 | 6f 6d 20 6d 61 6c 69 67 |ality fr|om malig|
|00004de0| 6e 61 6e 74 20 6d 65 6c | 61 6e 6f 6d 61 20 6f 76 |nant mel|anoma ov|
|00004df0| 65 72 20 74 69 6d 65 20 | 69 6e 20 74 68 65 20 65 |er time |in the e|
|00004e00| 6c 64 65 72 6c 79 20 53 | 77 69 73 73 0d 0a 70 6f |lderly S|wiss..po|
|00004e10| 70 75 6c 61 74 69 6f 6e | 20 69 6e 64 69 63 61 74 |pulation| indicat|
|00004e20| 65 73 20 74 68 65 20 6e | 65 65 64 20 66 6f 72 20 |es the n|eed for |
|00004e30| 65 64 75 63 61 74 69 6f | 6e 61 6c 20 63 61 6d 70 |educatio|nal camp|
|00004e40| 61 69 67 6e 73 20 74 68 | 61 74 20 73 70 65 63 69 |aigns th|at speci|
|00004e50| 66 69 63 61 6c 6c 79 0d | 0a 74 61 72 67 65 74 20 |fically.|.target |
|00004e60| 74 68 69 73 20 73 65 67 | 6d 65 6e 74 20 6f 66 20 |this seg|ment of |
|00004e70| 74 68 65 20 70 6f 70 75 | 6c 61 74 69 6f 6e 2e 0d |the popu|lation..|
|00004e80| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00004e90| 0a 0d 0a 20 20 20 20 20 | 49 6e 63 72 65 61 73 65 |...     |Increase|
|00004ea0| 64 20 6d 6f 72 74 61 6c | 69 74 79 20 66 72 6f 6d |d mortal|ity from|
|00004eb0| 20 6d 65 6c 61 6e 6f 6d | 61 20 69 6e 20 74 68 65 | melanom|a in the|
|00004ec0| 20 65 6c 64 65 72 6c 79 | 20 68 61 73 20 62 65 65 | elderly| has bee|
|00004ed0| 6e 20 73 65 65 6e 20 69 | 6e 20 73 65 76 65 72 61 |n seen i|n severa|
|00004ee0| 6c 0d 0a 73 65 72 69 65 | 73 2e 20 20 45 78 70 6c |l..serie|s.  Expl|
|00004ef0| 61 6e 61 74 69 6f 6e 73 | 20 68 61 76 65 20 69 6e |anations| have in|
|00004f00| 63 6c 75 64 65 64 20 64 | 65 6c 61 79 20 69 6e 20 |cluded d|elay in |
|00004f10| 64 69 61 67 6e 6f 73 69 | 73 2c 20 69 6e 63 72 65 |diagnosi|s, incre|
|00004f20| 61 73 65 64 20 66 72 65 | 71 75 65 6e 63 79 20 6f |ased fre|quency o|
|00004f30| 66 0d 0a 61 63 72 61 6c | 20 6c 65 73 69 6f 6e 73 |f..acral| lesions|
|00004f40| 20 77 69 74 68 20 61 73 | 73 6f 63 69 61 74 65 64 | with as|sociated|
|00004f50| 20 70 6f 6f 72 20 70 72 | 6f 67 6e 6f 73 69 73 2c | poor pr|ognosis,|
|00004f60| 20 61 6e 64 20 64 65 63 | 72 65 61 73 65 64 20 61 | and dec|reased a|
|00004f70| 67 65 2d 72 65 6c 61 74 | 65 64 20 69 6d 6d 75 6e |ge-relat|ed immun|
|00004f80| 65 0d 0a 73 75 72 76 65 | 69 6c 6c 61 6e 63 65 2e |e..surve|illance.|
|00004f90| 20 20 4e 6f 6e 65 20 6f | 66 20 74 68 65 73 65 20 |  None o|f these |
|00004fa0| 65 78 70 6c 61 6e 61 74 | 69 6f 6e 73 20 66 75 6c |explanat|ions ful|
|00004fb0| 6c 79 20 65 78 70 6c 61 | 69 6e 20 74 68 65 20 6f |ly expla|in the o|
|00004fc0| 62 73 65 72 76 65 64 0d | 0a 64 69 66 66 65 72 65 |bserved.|.differe|
|00004fd0| 6e 63 65 73 2e 20 20 49 | 6e 20 73 6f 6d 65 20 6d |nces.  I|n some m|
|00004fe0| 75 6c 74 69 76 61 72 69 | 61 74 65 20 61 6e 61 6c |ultivari|ate anal|
|00004ff0| 79 73 65 73 2c 20 61 67 | 65 20 69 73 20 65 6c 69 |yses, ag|e is eli|
|00005000| 6d 69 6e 61 74 65 64 20 | 61 73 20 61 6e 0d 0a 69 |minated |as an..i|
|00005010| 6e 64 65 70 65 6e 64 65 | 6e 74 20 76 61 72 69 61 |ndepende|nt varia|
|00005020| 62 6c 65 2e 2d 2d 41 2e | 4a 2e 20 53 6f 62 65 72 |ble.--A.|J. Sober|
|00005030| 2c 20 4d 2e 44 2e 0d 0a | 24 55 6e 69 71 75 65 5f |, M.D...|$Unique_|
|00005040| 49 44 7b 59 52 42 30 30 | 32 30 36 7d 0d 0a 24 54 |ID{YRB00|206}..$T|
|00005050| 69 74 6c 65 7b 4d 6f 64 | 65 6c 20 50 72 65 64 69 |itle{Mod|el Predi|
|00005060| 63 74 69 6e 67 20 53 75 | 72 76 69 76 61 6c 20 69 |cting Su|rvival i|
|00005070| 6e 20 53 74 61 67 65 20 | 49 20 4d 65 6c 61 6e 6f |n Stage |I Melano|
|00005080| 6d 61 20 42 61 73 65 64 | 20 6f 6e 20 54 75 6d 6f |ma Based| on Tumo|
|00005090| 72 0d 0a 50 72 6f 67 72 | 65 73 73 69 6f 6e 7d 0d |r..Progr|ession}.|
|000050a0| 0a 24 41 75 74 68 6f 72 | 7b 0d 0a 43 6c 61 72 6b |.$Author|{..Clark|
|000050b0| 2c 20 57 48 20 4a 72 0d | 0a 45 6c 64 65 72 2c 20 |, WH Jr.|.Elder, |
|000050c0| 44 45 0d 0a 47 75 65 72 | 72 79 2c 20 44 20 49 56 |DE..Guer|ry, D IV|
|000050d0| 0d 0a 42 72 61 69 74 6d | 61 6e 2c 20 4c 45 0d 0a |..Braitm|an, LE..|
|000050e0| 54 72 6f 63 6b 2c 20 42 | 4a 0d 0a 53 63 68 75 6c |Trock, B|J..Schul|
|000050f0| 74 7a 2c 20 44 0d 0a 53 | 79 6e 6e 65 73 74 76 65 |tz, D..S|ynnestve|
|00005100| 64 74 2c 20 4d 0d 0a 48 | 61 6c 70 65 72 6e 2c 20 |dt, M..H|alpern, |
|00005110| 41 43 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |AC}..$Af|filiatio|
|00005120| 6e 7b 55 6e 69 76 20 6f | 66 20 50 65 6e 6e 73 79 |n{Univ o|f Pennsy|
|00005130| 6c 76 61 6e 69 61 2c 20 | 50 68 69 6c 61 64 65 6c |lvania, |Philadel|
|00005140| 70 68 69 61 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |phia}..$|Journal{|
|00005150| 4a 20 4e 61 74 6c 20 43 | 61 6e 63 65 72 20 49 6e |J Natl C|ancer In|
|00005160| 73 74 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 38 31 7d |st}..$Vo|lume{81}|
|00005170| 0d 0a 24 50 61 67 65 7b | 31 38 39 33 2d 31 39 30 |..$Page{|1893-190|
|00005180| 34 7d 0d 0a 24 44 61 74 | 65 7b 31 39 38 39 7d 0d |4}..$Dat|e{1989}.|
|00005190| 0a 24 59 42 56 6f 6c 7b | 31 39 39 31 20 59 65 61 |.$YBVol{|1991 Yea|
|000051a0| 72 20 42 6f 6f 6b 20 6f | 66 20 44 65 72 6d 61 74 |r Book o|f Dermat|
|000051b0| 6f 6c 6f 67 79 7d 0d 0a | 24 43 68 61 70 74 65 72 |ology}..|$Chapter|
|000051c0| 7b 31 33 2d 34 39 7d 0d | 0a 24 59 42 45 64 69 74 |{13-49}.|.$YBEdit|
|000051d0| 6f 72 7b 44 72 73 2e 20 | 20 53 6f 62 65 72 20 61 |or{Drs. | Sober a|
|000051e0| 6e 64 20 46 69 74 7a 70 | 61 74 72 69 63 6b 7d 0d |nd Fitzp|atrick}.|
|000051f0| 0a 24 54 61 62 6c 65 7b | 54 61 62 6c 65 20 4f 6d |.$Table{|Table Om|
|00005200| 69 74 74 65 64 7d 0d 0a | 24 43 6f 6d 6d 65 6e 74 |itted}..|$Comment|
|00005210| 61 74 6f 72 7b 41 2e 4a | 2e 20 20 53 6f 62 65 72 |ator{A.J|.  Sober|
|00005220| 2c 20 4d 2e 44 2e 7d 0d | 0a 0d 0a 43 6f 70 79 72 |, M.D.}.|...Copyr|
|00005230| 69 67 68 74 20 28 43 29 | 20 59 65 61 72 20 42 6f |ight (C)| Year Bo|
|00005240| 6f 6b 20 4d 65 64 69 63 | 61 6c 20 50 75 62 6c 69 |ok Medic|al Publi|
|00005250| 73 68 65 72 73 2c 20 49 | 6e 63 2e 20 20 31 39 39 |shers, I|nc.  199|
|00005260| 31 0d 0a 0d 0a 31 39 39 | 31 20 59 65 61 72 20 42 |1....199|1 Year B|
|00005270| 6f 6f 6b 20 6f 66 20 44 | 65 72 6d 61 74 6f 6c 6f |ook of D|ermatolo|
|00005280| 67 79 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 31 33 |gy....Ch|apter 13|
|00005290| 2d 2d 4d 65 6c 61 6e 6f | 63 79 74 69 63 20 4e 65 |--Melano|cytic Ne|
|000052a0| 76 69 20 61 6e 64 20 4d | 65 6c 61 6e 6f 6d 61 0d |vi and M|elanoma.|
|000052b0| 0a 0d 0a 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |...-----|--------|
|000052c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005300| 2d 0d 0a 4d 6f 64 65 6c | 20 50 72 65 64 69 63 74 |-..Model| Predict|
|00005310| 69 6e 67 20 53 75 72 76 | 69 76 61 6c 20 69 6e 20 |ing Surv|ival in |
|00005320| 53 74 61 67 65 20 49 20 | 4d 65 6c 61 6e 6f 6d 61 |Stage I |Melanoma|
|00005330| 20 42 61 73 65 64 20 6f | 6e 20 54 75 6d 6f 72 20 | Based o|n Tumor |
|00005340| 50 72 6f 67 72 65 73 73 | 69 6f 6e 0d 0a 0d 0a 43 |Progress|ion....C|
|00005350| 6c 61 72 6b 20 57 48 20 | 4a 72 3b 20 45 6c 64 65 |lark WH |Jr; Elde|
|00005360| 72 20 44 45 3b 20 47 75 | 65 72 72 79 20 44 20 49 |r DE; Gu|erry D I|
|00005370| 56 3b 20 42 72 61 69 74 | 6d 61 6e 20 4c 45 3b 20 |V; Brait|man LE; |
|00005380| 54 72 6f 63 6b 20 42 4a | 3b 20 53 63 68 75 6c 74 |Trock BJ|; Schult|
|00005390| 7a 20 44 3b 0d 0a 53 79 | 6e 6e 65 73 74 76 65 64 |z D;..Sy|nnestved|
|000053a0| 74 20 4d 3b 20 48 61 6c | 70 65 72 6e 20 41 43 0d |t M; Hal|pern AC.|
|000053b0| 0a 28 55 6e 69 76 20 6f | 66 20 50 65 6e 6e 73 79 |.(Univ o|f Pennsy|
|000053c0| 6c 76 61 6e 69 61 2c 20 | 50 68 69 6c 61 64 65 6c |lvania, |Philadel|
|000053d0| 70 68 69 61 29 0d 0a 4a | 20 4e 61 74 6c 20 43 61 |phia)..J| Natl Ca|
|000053e0| 6e 63 65 72 20 49 6e 73 | 74 20 38 31 3a 31 38 39 |ncer Ins|t 81:189|
|000053f0| 33 2d 31 39 30 34 2c 20 | 31 39 38 39 0d 0a 2d 2d |3-1904, |1989..--|
|00005400| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005410| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005420| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00005450| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00005460| 20 41 6c 74 68 6f 75 67 | 68 20 74 75 6d 6f 72 20 | Althoug|h tumor |
|00005470| 74 68 69 63 6b 6e 65 73 | 73 20 69 73 20 61 6e 20 |thicknes|s is an |
|00005480| 65 78 63 65 6c 6c 65 6e | 74 20 70 72 6f 67 6e 6f |excellen|t progno|
|00005490| 73 74 69 63 20 6d 61 72 | 6b 65 72 20 66 6f 72 20 |stic mar|ker for |
|000054a0| 73 74 61 67 65 20 49 0d | 0a 6d 65 6c 61 6e 6f 6d |stage I.|.melanom|
|000054b0| 61 2c 20 64 65 61 74 68 | 73 20 6f 63 63 75 72 20 |a, death|s occur |
|000054c0| 66 72 6f 6d 20 74 68 69 | 6e 20 6d 65 6c 61 6e 6f |from thi|n melano|
|000054d0| 6d 61 73 20 61 6e 64 20 | 73 6f 6d 65 20 70 61 74 |mas and |some pat|
|000054e0| 69 65 6e 74 73 20 77 69 | 74 68 20 74 68 65 20 74 |ients wi|th the t|
|000054f0| 68 69 63 6b 65 73 74 0d | 0a 6c 65 73 69 6f 6e 73 |hickest.|.lesions|
|00005500| 20 73 75 72 76 69 76 65 | 2e 20 20 54 68 65 20 6d | survive|.  The m|
|00005510| 75 6c 74 69 76 61 72 69 | 61 62 6c 65 20 6c 6f 67 |ultivari|able log|
|00005520| 69 73 74 69 63 20 72 65 | 67 72 65 73 73 69 6f 6e |istic re|gression|
|00005530| 20 61 70 70 72 6f 61 63 | 68 20 77 61 73 20 75 73 | approac|h was us|
|00005540| 65 64 20 74 6f 0d 0a 63 | 72 65 61 74 65 20 61 20 |ed to..c|reate a |
|00005550| 70 72 6f 67 6e 6f 73 74 | 69 63 20 6d 6f 64 65 6c |prognost|ic model|
|00005560| 20 66 6f 72 20 70 72 69 | 6d 61 72 79 20 63 6c 69 | for pri|mary cli|
|00005570| 6e 69 63 61 6c 20 73 74 | 61 67 65 20 49 20 63 75 |nical st|age I cu|
|00005580| 74 61 6e 65 6f 75 73 20 | 6d 65 6c 61 6e 6f 6d 61 |taneous |melanoma|
|00005590| 2e 0d 0a 54 68 65 20 64 | 61 74 61 20 62 61 73 65 |...The d|ata base|
|000055a0| 20 69 6e 63 6c 75 64 65 | 64 20 35 30 31 20 69 6e | include|d 501 in|
|000055b0| 63 69 64 65 6e 74 20 63 | 61 73 65 73 20 6f 66 20 |cident c|ases of |
|000055c0| 6d 65 6c 61 6e 6f 6d 61 | 20 73 65 65 6e 20 69 6e |melanoma| seen in|
|000055d0| 20 31 39 37 32 2d 31 39 | 37 38 2e 20 20 54 68 65 | 1972-19|78.  The|
|000055e0| 0d 0a 6d 6f 64 65 6c 20 | 64 65 76 65 6c 6f 70 65 |..model |develope|
|000055f0| 64 20 6f 6e 20 74 68 65 | 20 64 65 66 69 6e 69 74 |d on the| definit|
|00005600| 69 76 65 20 73 74 75 64 | 79 20 67 72 6f 75 70 20 |ive stud|y group |
|00005610| 77 61 73 20 76 61 6c 69 | 64 61 74 65 64 20 75 73 |was vali|dated us|
|00005620| 69 6e 67 20 61 20 73 61 | 6d 70 6c 65 20 6f 66 0d |ing a sa|mple of.|
|00005630| 0a 31 32 35 20 69 6e 63 | 69 64 65 6e 74 20 63 61 |.125 inc|ident ca|
|00005640| 73 65 73 20 73 65 65 6e | 20 69 6e 20 31 39 37 39 |ses seen| in 1979|
|00005650| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 69 6e 76 61 |...     |The inva|
|00005660| 73 69 76 65 20 72 61 64 | 69 61 6c 20 67 72 6f 77 |sive rad|ial grow|
|00005670| 74 68 20 70 68 61 73 65 | 20 61 6e 64 20 76 65 72 |th phase| and ver|
|00005680| 74 69 63 61 6c 20 67 72 | 6f 77 74 68 20 70 68 61 |tical gr|owth pha|
|00005690| 73 65 20 6f 66 20 6d 65 | 6c 61 6e 6f 6d 61 73 0d |se of me|lanomas.|
|000056a0| 0a 61 72 65 20 63 6f 6d | 70 61 72 65 64 20 69 6e |.are com|pared in|
|000056b0| 20 54 61 62 6c 65 20 31 | 2e 20 20 54 68 65 20 67 | Table 1|.  The g|
|000056c0| 6f 61 6c 20 77 61 73 20 | 74 6f 20 63 72 65 61 74 |oal was |to creat|
|000056d0| 65 20 61 20 6d 6f 64 65 | 6c 20 66 6f 72 20 70 72 |e a mode|l for pr|
|000056e0| 65 64 69 63 74 69 6e 67 | 20 74 68 65 0d 0a 70 72 |edicting| the..pr|
|000056f0| 6f 62 61 62 69 6c 69 74 | 79 20 6f 66 20 38 2d 79 |obabilit|y of 8-y|
|00005700| 65 61 72 20 73 75 72 76 | 69 76 61 6c 2e 20 20 45 |ear surv|ival.  E|
|00005710| 61 63 68 20 6f 66 20 32 | 33 20 70 6f 74 65 6e 74 |ach of 2|3 potent|
|00005720| 69 61 6c 20 70 72 6f 67 | 6e 6f 73 74 69 63 20 61 |ial prog|nostic a|
|00005730| 6e 64 0d 0a 63 6f 6e 66 | 6f 75 6e 64 69 6e 67 20 |nd..conf|ounding |
|00005740| 66 61 63 74 6f 72 73 20 | 77 61 73 20 74 65 73 74 |factors |was test|
|00005750| 65 64 20 69 6e 64 65 70 | 65 6e 64 65 6e 74 6c 79 |ed indep|endently|
|00005760| 20 75 73 69 6e 67 20 61 | 20 75 6e 69 76 61 72 69 | using a| univari|
|00005770| 61 62 6c 65 20 6c 6f 67 | 69 73 74 69 63 0d 0a 6d |able log|istic..m|
|00005780| 6f 64 65 6c 2e 20 20 50 | 72 65 64 69 63 74 6f 72 |odel.  P|redictor|
|00005790| 73 20 65 6e 74 65 72 69 | 6e 67 20 74 68 65 20 6d |s enteri|ng the m|
|000057a0| 6f 64 65 6c 20 66 6f 72 | 20 76 65 72 74 69 63 61 |odel for| vertica|
|000057b0| 6c 2d 67 72 6f 77 74 68 | 2d 70 68 61 73 65 20 6d |l-growth|-phase m|
|000057c0| 65 6c 61 6e 6f 6d 61 73 | 0d 0a 28 54 61 62 6c 65 |elanomas|..(Table|
|000057d0| 20 32 29 20 69 6e 63 6c | 75 64 65 64 20 6d 69 74 | 2) incl|uded mit|
|000057e0| 6f 74 69 63 20 72 61 74 | 65 2c 20 74 75 6d 6f 72 |otic rat|e, tumor|
|000057f0| 2d 69 6e 66 69 6c 74 72 | 61 74 69 6e 67 20 6c 79 |-infiltr|ating ly|
|00005800| 6d 70 68 6f 63 79 74 65 | 73 2c 20 74 75 6d 6f 72 |mphocyte|s, tumor|
|00005810| 0d 0a 74 68 69 63 6b 6e | 65 73 73 2c 20 74 75 6d |..thickn|ess, tum|
|00005820| 6f 72 20 73 69 74 65 2c | 20 67 65 6e 64 65 72 2c |or site,| gender,|
|00005830| 20 61 6e 64 20 68 69 73 | 74 6f 6c 6f 67 69 63 20 | and his|tologic |
|00005840| 72 65 67 72 65 73 73 69 | 6f 6e 2e 0d 0a 20 20 20 |regressi|on...   |
|00005850| 20 20 4e 6f 6e 65 20 6f | 66 20 31 32 32 20 6d 65 |  None o|f 122 me|
|00005860| 6c 61 6e 6f 6d 61 73 20 | 69 6e 20 74 68 65 20 72 |lanomas |in the r|
|00005870| 61 64 69 61 6c 20 67 72 | 6f 77 74 68 20 70 68 61 |adial gr|owth pha|
|00005880| 73 65 20 6d 65 74 61 73 | 74 61 73 69 7a 65 64 2c |se metas|tasized,|
|00005890| 20 61 6e 64 20 61 6c 6c | 0d 0a 74 68 65 73 65 20 | and all|..these |
|000058a0| 70 61 74 69 65 6e 74 73 | 20 73 75 72 76 69 76 65 |patients| survive|
|000058b0| 64 2e 20 20 54 68 65 20 | 6c 69 6b 65 6c 69 68 6f |d.  The |likeliho|
|000058c0| 6f 64 20 6f 66 20 73 75 | 72 76 69 76 61 6c 20 69 |od of su|rvival i|
|000058d0| 73 20 72 65 6c 61 74 65 | 64 20 74 6f 20 74 68 65 |s relate|d to the|
|000058e0| 20 76 61 72 69 6f 75 73 | 0d 0a 69 6e 64 65 70 65 | various|..indepe|
|000058f0| 6e 64 65 6e 74 20 70 72 | 65 64 69 63 74 6f 72 73 |ndent pr|edictors|
|00005900| 20 69 6e 20 54 61 62 6c | 65 73 20 33 20 61 6e 64 | in Tabl|es 3 and|
|00005910| 20 34 2c 20 70 70 20 32 | 31 33 20 61 6e 64 20 32 | 4, pp 2|13 and 2|
|00005920| 31 34 2e 20 20 54 68 65 | 20 38 2d 79 65 61 72 20 |14.  The| 8-year |
|00005930| 73 75 72 76 69 76 61 6c | 0d 0a 66 6f 72 20 32 36 |survival|..for 26|
|00005940| 34 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |4 patien|ts with |
|00005950| 76 65 72 74 69 63 61 6c | 2d 67 72 6f 77 74 68 2d |vertical|-growth-|
|00005960| 70 68 61 73 65 20 6c 65 | 73 69 6f 6e 73 20 77 61 |phase le|sions wa|
|00005970| 73 20 37 31 2e 32 25 2e | 20 20 54 68 69 73 20 69 |s 71.2%.|  This i|
|00005980| 73 20 74 68 65 0d 0a 6d | 6f 73 74 20 61 63 63 75 |s the..m|ost accu|
|00005990| 72 61 74 65 20 6d 65 61 | 6e 73 20 6f 66 20 70 72 |rate mea|ns of pr|
|000059a0| 65 64 69 63 74 69 6e 67 | 20 73 75 72 76 69 76 61 |edicting| surviva|
|000059b0| 6c 20 69 6e 20 73 74 61 | 67 65 20 49 20 6d 65 6c |l in sta|ge I mel|
|000059c0| 61 6e 6f 6d 61 2e 20 20 | 54 68 65 20 69 6d 70 6f |anoma.  |The impo|
|000059d0| 72 74 61 6e 74 0d 0a 70 | 72 6f 67 6e 6f 73 74 69 |rtant..p|rognosti|
|000059e0| 63 20 66 61 63 74 6f 72 | 73 20 73 68 6f 75 6c 64 |c factor|s should|
|000059f0| 20 70 72 6f 76 65 20 75 | 73 65 66 75 6c 20 77 68 | prove u|seful wh|
|00005a00| 65 6e 20 64 65 73 69 67 | 6e 69 6e 67 20 69 6e 20 |en desig|ning in |
|00005a10| 76 69 74 72 6f 20 73 74 | 75 64 69 65 73 20 6f 6e |vitro st|udies on|
|00005a20| 20 74 68 65 0d 0a 62 69 | 6f 6c 6f 67 79 20 6f 66 | the..bi|ology of|
|00005a30| 20 6d 65 74 61 73 74 61 | 73 69 73 20 61 6e 64 20 | metasta|sis and |
|00005a40| 74 68 65 20 6e 61 74 75 | 72 65 20 6f 66 20 74 75 |the natu|re of tu|
|00005a50| 6d 6f 72 20 70 72 6f 67 | 72 65 73 73 69 6f 6e 2e |mor prog|ression.|
|00005a60| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|00005a70| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 69 73 20 69 73 |....    | This is|
|00005a80| 20 61 20 6c 61 6e 64 6d | 61 72 6b 20 70 61 70 65 | a landm|ark pape|
|00005a90| 72 20 74 68 65 20 6f 62 | 73 65 72 76 61 74 69 6f |r the ob|servatio|
|00005aa0| 6e 73 20 6f 66 20 77 68 | 69 63 68 20 6d 75 73 74 |ns of wh|ich must|
|00005ab0| 20 62 65 20 63 6f 6e 66 | 69 72 6d 65 64 20 62 79 | be conf|irmed by|
|00005ac0| 0d 0a 6f 74 68 65 72 20 | 69 6e 76 65 73 74 69 67 |..other |investig|
|00005ad0| 61 74 6f 72 73 2e 20 20 | 49 66 20 76 61 6c 69 64 |ators.  |If valid|
|00005ae0| 61 74 65 64 2c 20 70 61 | 74 69 65 6e 74 73 20 77 |ated, pa|tients w|
|00005af0| 69 74 68 20 72 61 64 69 | 61 6c 2d 67 72 6f 77 74 |ith radi|al-growt|
|00005b00| 68 2d 70 68 61 73 65 20 | 6d 65 6c 61 6e 6f 6d 61 |h-phase |melanoma|
|00005b10| 0d 0a 63 61 6e 20 62 65 | 20 72 65 67 61 72 64 65 |..can be| regarde|
|00005b20| 64 20 61 73 20 68 61 76 | 69 6e 67 20 62 65 6e 69 |d as hav|ing beni|
|00005b30| 67 6e 20 64 69 73 65 61 | 73 65 20 61 6e 64 20 73 |gn disea|se and s|
|00005b40| 68 6f 75 6c 64 20 62 65 | 20 61 62 6c 65 20 74 6f |hould be| able to|
|00005b50| 20 6f 62 74 61 69 6e 20 | 6c 69 66 65 20 61 6e 64 | obtain |life and|
|00005b60| 0d 0a 64 69 73 61 62 69 | 6c 69 74 79 20 69 6e 73 |..disabi|lity ins|
|00005b70| 75 72 61 6e 63 65 20 61 | 74 20 73 74 61 6e 64 61 |urance a|t standa|
|00005b80| 72 64 20 72 61 74 65 73 | 2e 20 20 46 6f 72 20 70 |rd rates|.  For p|
|00005b90| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 76 65 72 |atients |with ver|
|00005ba0| 74 69 63 61 6c 20 67 72 | 6f 77 74 68 0d 0a 70 68 |tical gr|owth..ph|
|00005bb0| 61 73 65 20 6d 65 6c 61 | 6e 6f 6d 61 2c 20 74 68 |ase mela|noma, th|
|00005bc0| 65 20 74 61 62 6c 65 73 | 20 73 68 6f 75 6c 64 20 |e tables| should |
|00005bd0| 70 72 6f 76 69 64 65 20 | 61 20 6d 6f 72 65 20 61 |provide |a more a|
|00005be0| 63 63 75 72 61 74 65 20 | 61 73 73 65 73 73 6d 65 |ccurate |assessme|
|00005bf0| 6e 74 20 6f 66 0d 0a 69 | 6e 64 69 76 69 64 75 61 |nt of..i|ndividua|
|00005c00| 6c 20 72 69 73 6b 20 74 | 68 61 6e 20 74 68 61 74 |l risk t|han that|
|00005c10| 20 6f 62 74 61 69 6e 65 | 64 20 62 79 20 70 72 69 | obtaine|d by pri|
|00005c20| 6d 61 72 79 20 74 75 6d | 6f 72 20 74 68 69 63 6b |mary tum|or thick|
|00005c30| 6e 65 73 73 20 61 6c 6f | 6e 65 2e 20 20 49 74 0d |ness alo|ne.  It.|
|00005c40| 0a 72 65 6d 61 69 6e 73 | 20 74 6f 20 62 65 20 73 |.remains| to be s|
|00005c50| 65 65 6e 20 77 68 65 74 | 68 65 72 20 74 68 65 20 |een whet|her the |
|00005c60| 6d 61 6a 6f 72 69 74 79 | 20 6f 66 20 70 61 74 68 |majority| of path|
|00005c70| 6f 6c 6f 67 69 73 74 73 | 20 77 69 6c 6c 20 62 65 |ologists| will be|
|00005c80| 20 61 62 6c 65 20 74 6f | 0d 0a 64 69 73 74 69 6e | able to|..distin|
|00005c90| 67 75 69 73 68 20 65 61 | 72 6c 79 20 76 65 72 74 |guish ea|rly vert|
|00005ca0| 69 63 61 6c 2d 67 72 6f | 77 74 68 2d 70 68 61 73 |ical-gro|wth-phas|
|00005cb0| 65 20 6d 65 6c 61 6e 6f | 6d 61 20 66 72 6f 6d 20 |e melano|ma from |
|00005cc0| 72 61 64 69 61 6c 2d 67 | 72 6f 77 74 68 2d 70 68 |radial-g|rowth-ph|
|00005cd0| 61 73 65 0d 0a 6d 65 6c | 61 6e 6f 6d 61 2c 20 61 |ase..mel|anoma, a|
|00005ce0| 6e 64 20 77 68 65 74 68 | 65 72 20 72 65 67 72 65 |nd wheth|er regre|
|00005cf0| 73 73 69 6f 6e 20 61 6e | 64 20 74 75 6d 6f 72 20 |ssion an|d tumor |
|00005d00| 69 6e 66 69 6c 74 72 61 | 74 69 6e 67 20 6c 79 6d |infiltra|ting lym|
|00005d10| 70 68 6f 63 79 74 65 73 | 20 63 61 6e 20 62 65 0d |phocytes| can be.|
|00005d20| 0a 63 6f 6e 73 69 73 74 | 65 6e 74 6c 79 20 72 65 |.consist|ently re|
|00005d30| 63 6f 67 6e 69 7a 65 64 | 2e 2d 2d 41 2e 4a 2e 20 |cognized|.--A.J. |
|00005d40| 53 6f 62 65 72 2c 20 4d | 2e 44 2e 0d 0a 24 55 6e |Sober, M|.D...$Un|
|00005d50| 69 71 75 65 5f 49 44 7b | 59 52 42 30 30 32 30 37 |ique_ID{|YRB00207|
|00005d60| 7d 0d 0a 24 54 69 74 6c | 65 7b 4d 6f 72 70 68 6f |}..$Titl|e{Morpho|
|00005d70| 6d 65 74 72 69 63 20 44 | 69 61 67 6e 6f 73 69 73 |metric D|iagnosis|
|00005d80| 20 6f 66 20 4d 65 6c 61 | 6e 6f 63 79 74 69 63 20 | of Mela|nocytic |
|00005d90| 53 6b 69 6e 20 54 75 6d | 6f 72 73 7d 0d 0a 24 41 |Skin Tum|ors}..$A|
|00005da0| 75 74 68 6f 72 7b 0d 0a | 4c 65 69 74 69 6e 67 65 |uthor{..|Leitinge|
|00005db0| 72 2c 20 47 0d 0a 43 65 | 72 72 6f 6e 69 2c 20 4c |r, G..Ce|rroni, L|
|00005dc0| 0d 0a 53 6f 79 65 72 2c | 20 48 50 0d 0a 53 6d 6f |..Soyer,| HP..Smo|
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|00005e10| 75 72 6e 61 6c 7b 41 6d | 20 4a 20 44 65 72 6d 61 |urnal{Am| J Derma|
|00005e20| 74 6f 70 61 74 68 6f 6c | 7d 0d 0a 24 56 6f 6c 75 |topathol|}..$Volu|
|00005e30| 6d 65 7b 31 32 7d 0d 0a | 24 50 61 67 65 7b 34 34 |me{12}..|$Page{44|
|00005e40| 31 2d 34 34 35 7d 0d 0a | 24 44 61 74 65 7b 31 39 |1-445}..|$Date{19|
|00005e50| 39 30 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 31 |90}..$YB|Vol{1991|
|00005e60| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 44 65 | Year Bo|ok of De|
|00005e70| 72 6d 61 74 6f 6c 6f 67 | 79 7d 0d 0a 24 43 68 61 |rmatolog|y}..$Cha|
|00005e80| 70 74 65 72 7b 31 33 2d | 35 30 7d 0d 0a 24 59 42 |pter{13-|50}..$YB|
|00005e90| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 20 53 6f 62 |Editor{D|rs.  Sob|
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|00005ec0| 43 6f 6d 6d 65 6e 74 61 | 74 6f 72 7b 54 2e 4a 2e |Commenta|tor{T.J.|
|00005ed0| 20 20 46 6c 6f 74 74 65 | 2c 20 4d 2e 44 2e 7d 0d |  Flotte|, M.D.}.|
|00005ee0| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 43 29 |...Copyr|ight (C)|
|00005ef0| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
|00005f00| 61 6c 20 50 75 62 6c 69 | 73 68 65 72 73 2c 20 49 |al Publi|shers, I|
|00005f10| 6e 63 2e 20 20 31 39 39 | 31 0d 0a 0d 0a 31 39 39 |nc.  199|1....199|
|00005f20| 31 20 59 65 61 72 20 42 | 6f 6f 6b 20 6f 66 20 44 |1 Year B|ook of D|
|00005f30| 65 72 6d 61 74 6f 6c 6f | 67 79 0d 0a 0d 0a 43 68 |ermatolo|gy....Ch|
|00005f40| 61 70 74 65 72 20 31 33 | 2d 2d 4d 65 6c 61 6e 6f |apter 13|--Melano|
|00005f50| 63 79 74 69 63 20 4e 65 | 76 69 20 61 6e 64 20 4d |cytic Ne|vi and M|
|00005f60| 65 6c 61 6e 6f 6d 61 0d | 0a 0d 0a 2d 2d 2d 2d 2d |elanoma.|...-----|
|00005f70| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005f80| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005f90| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fa0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005fb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 4d 6f 72 70 68 |--------|-..Morph|
|00005fc0| 6f 6d 65 74 72 69 63 20 | 44 69 61 67 6e 6f 73 69 |ometric |Diagnosi|
|00005fd0| 73 20 6f 66 20 4d 65 6c | 61 6e 6f 63 79 74 69 63 |s of Mel|anocytic|
|00005fe0| 20 53 6b 69 6e 20 54 75 | 6d 6f 72 73 0d 0a 0d 0a | Skin Tu|mors....|
|00005ff0| 4c 65 69 74 69 6e 67 65 | 72 20 47 3b 20 43 65 72 |Leitinge|r G; Cer|
|00006000| 72 6f 6e 69 20 4c 3b 20 | 53 6f 79 65 72 20 48 50 |roni L; |Soyer HP|
|00006010| 3b 20 53 6d 6f 6c 6c 65 | 20 4a 3b 20 4b 65 72 6c |; Smolle| J; Kerl|
|00006020| 20 48 0d 0a 28 55 6e 69 | 76 65 72 73 69 74 79 20 | H..(Uni|versity |
|00006030| 6f 66 20 47 72 61 7a 2c | 20 41 75 73 74 72 69 61 |of Graz,| Austria|
|00006040| 29 0d 0a 41 6d 20 4a 20 | 44 65 72 6d 61 74 6f 70 |)..Am J |Dermatop|
|00006050| 61 74 68 6f 6c 20 31 32 | 3a 34 34 31 2d 34 34 35 |athol 12|:441-445|
|00006060| 2c 20 31 39 39 30 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |, 1990..|--------|
|00006070| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006080| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00006090| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000060b0| 2d 2d 2d 2d 2d 2d 0d 0a | 0d 0a 41 62 73 74 72 61 |------..|..Abstra|
|000060c0| 63 74 0d 0a 0d 0a 20 20 | 20 20 20 4d 6f 72 70 68 |ct....  |   Morph|
|000060d0| 6f 6d 65 74 72 79 20 68 | 61 73 20 62 65 65 6e 20 |ometry h|as been |
|000060e0| 73 75 63 63 65 73 73 66 | 75 6c 6c 79 20 61 70 70 |successf|ully app|
|000060f0| 6c 69 65 64 20 74 6f 20 | 64 69 66 66 65 72 65 6e |lied to |differen|
|00006100| 74 69 61 6c 20 64 69 61 | 67 6e 6f 73 69 73 20 6f |tial dia|gnosis o|
|00006110| 66 0d 0a 74 75 6d 6f 72 | 73 2e 20 20 54 68 65 20 |f..tumor|s.  The |
|00006120| 6d 61 74 75 72 61 74 69 | 6f 6e 20 70 61 72 61 6d |maturati|on param|
|00006130| 65 74 65 72 20 68 61 73 | 20 62 65 65 6e 20 65 73 |eter has| been es|
|00006140| 70 65 63 69 61 6c 6c 79 | 20 75 73 65 66 75 6c 20 |pecially| useful |
|00006150| 69 6e 0d 0a 64 69 66 66 | 65 72 65 6e 74 69 61 74 |in..diff|erentiat|
|00006160| 69 6e 67 20 53 70 69 74 | 7a 20 6e 65 76 75 73 20 |ing Spit|z nevus |
|00006170| 66 72 6f 6d 20 6d 61 6c | 69 67 6e 61 6e 74 20 6d |from mal|ignant m|
|00006180| 65 6c 61 6e 6f 6d 61 2e | 20 20 54 68 65 20 75 73 |elanoma.|  The us|
|00006190| 65 66 75 6c 6e 65 73 73 | 20 6f 66 20 74 68 65 73 |efulness| of thes|
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|000061b0| 76 61 6c 75 61 74 65 64 | 20 69 6e 20 32 30 36 20 |valuated| in 206 |
|000061c0| 63 6f 6e 73 65 63 75 74 | 69 76 65 6c 79 20 65 78 |consecut|ively ex|
|000061d0| 63 69 73 65 64 20 6d 65 | 6c 61 6e 6f 63 79 74 69 |cised me|lanocyti|
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|00006220| 20 77 65 72 65 20 31 33 | 33 20 62 65 6e 69 67 6e | were 13|3 benign|
|00006230| 20 64 65 72 6d 61 6c 20 | 6e 65 76 69 2c 20 32 30 | dermal |nevi, 20|
|00006240| 0d 0a 53 70 69 74 7a 20 | 6e 65 76 69 2c 20 61 6e |..Spitz |nevi, an|
|00006250| 64 20 35 33 20 70 72 69 | 6d 61 72 79 20 6d 61 6c |d 53 pri|mary mal|
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|00006290| 0a 61 20 6d 69 6e 69 6d | 75 6d 20 6f 66 20 36 30 |.a minim|um of 60|
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|00006330| 65 6d 2e 20 20 54 68 65 | 20 6d 61 74 75 72 61 74 |em.  The| maturat|
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|00006350| 73 20 63 61 6c 63 75 6c | 61 74 65 64 20 61 73 20 |s calcul|ated as |
|00006360| 74 68 65 20 72 61 74 69 | 6f 20 6f 66 20 74 68 65 |the rati|o of the|
|00006370| 20 6d 65 61 6e 0d 0a 6e | 75 63 6c 65 61 72 20 61 | mean..n|uclear a|
|00006380| 72 65 61 20 69 6e 20 74 | 68 65 20 64 65 65 70 20 |rea in t|he deep |
|00006390| 61 6e 64 20 73 75 70 65 | 72 66 69 63 69 61 6c 20 |and supe|rficial |
|000063a0| 70 6f 72 74 69 6f 6e 73 | 20 6f 66 20 74 68 65 20 |portions| of the |
|000063b0| 74 75 6d 6f 72 2e 0d 0a | 20 20 20 20 20 43 6f 6d |tumor...|     Com|
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|000063f0| 64 20 74 68 61 74 20 74 | 68 65 20 6c 6f 77 65 73 |d that t|he lowes|
+--------+-------------------------+-------------------------+--------+--------+