title: Parathyroid hormone-related protein and hypercalcemia in patients with metastatic melanoma: case report and review.
abstract: Hypercalcemia associated with malignancy has been attributed to osteolytic processes secondary to bony metastases and to humoral factors causing increased bone resorption and decreased renal excretion of calcium. Parathyroid hormone-related protein (PTH-rP) is a humoral factor that has been associated with hypercalcemia in renal cell carcinoma, squamous cell carcinoma, and bladder carcinoma. Hypercalcemia does occur in patients with melanoma; however, few studies have reported on hypercalcemia in these patients, and even fewer have described a direct connection to PTH-rP. We here report a patient with stage IV malignant melanoma presenting with severe hypercalcemia associated with elevated PTH-rP levels. Immunohistochemistry showed strong expression of PTH-rP in biopsy of the patient's subcutaneous masses. In addition, we found a 4.9% incidence of hypercalcemia in 1,146 consecutive patients treated for metastatic melanoma at the Surgery Branch of the National Cancer Institute between January 1, 1988 and March 31, 2000. Thus, PTH-rP may play a significant role in severe hypercalcemia in patients with metastatic melanoma. The discovery of PTH-rP and relevant literature will also be reviewed.
authors.affiliation: Surgery Branch, Laboratory of Pathology, National Institute of Health, Bethesda, Maryland 20892, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Attia
authors.forename: Giao Q
authors.initials: GQ
authors.lastname: Phan
authors.forename: Paul H
authors.initials: PH
authors.lastname: Duray
authors.forename: Steven A
authors.initials: SA
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology*; D007150:Immunohistochemistry; D007167:Immunotherapy; D007376:Interleukin-2 / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000150:complications* / Q000378:metabolism* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy; D013125:Spinal Neoplasms / Q000556:secondary / Q000628:therapy
chemical_list: D007376:Interleukin-2; D010281:Parathyroid Hormone