Transsphenoidal hypophysectomy was performed in 13 patients with advanced malignant melanoma. Although three minor responses were observed, there were no complete or partial responses. All three patients with bone pain had a decrease in discomfort lasting 1-2 months. All five patients with minor responses or stable disease had postoperative decreases in the excretion of the dihydroxyphenylalanine (DOPA) metabolite 3-0-methyldopamine; all but one patient with clinical progression had postoperative increases in excretion. Average survival of those whose postoperative excretion fell (143+ days; range, 60-217+) was significantly longer (P < 0.004) than that of those whose postsurgical values rose (30 days; range, 15-58).
Cancer 51 : 1541 -1 545, 1983.
YPOPHYSECTOMY is useful for palliation of carci-H nomas of the and prostate gland.'-12 Pituitary ablation has also been performed sporadically in patients with malignant melanoma, with varied results. Wigby and Metz13 reported one partial remission of widespread visceral and cutaneous melanoma in five patients treated with high voltage radiation to the pi- tuitary gland. Shimkin et d.14 observed that hypophysectomy did not alter the course of melanoma in one patient. Kelly ef al." noted no effect on melanoma progression after pituitary irradiation in one subject; it is doubtful, however, that complete ablation was achieved since no signs of hypopituitarism were noted. Menning16 reported that eight of 15 patients with melanoma who underwent surgical removal of the pituitary at various centers showed regression of disease, but details of disease distribution and criteria used to assess response were not given. The recent development of the transsphenoidal approach to hypophysectomy '' has made widespread use of this operation more feasible. Because