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< Current issue
Dermatopathology: Practical & Conceptual January - March 2001
>
Evolution In Thinking: Criteria for Histopathologic Diagnosis of Melanoma, 1947–2000: A Critique in Historical Perspective
Mary Aldrene L. Tan, M.D.
A. Bernard Ackerman, M.D.
Introduction
Becker and Obermayer
Ormsby and Montgomery
Lever
Allen
Percival, Montgomery, and Dodds
Montgomery
Pinkus and Mehregan
Wayte
Clark and Mihm
Milne
Smith
Sanderson
Smith
Price, Rywlin, and Ackerman
Pinkus and Mehregan
Ackerman and Su
Kamino and Ackerman
Domonkos, Arnold, and Odom
Roses, Harris, and Ackerman
MacKie
Okun, Edelstein, and Fisher
McCarthy
et al.
Clark
Kirkham
Weedon and Strutton
Fitzpatrick
et al.
Murphy
Mehregan
et al.
Weedon
Elder and Elenitsas
Barnhill
Langley, Fitzpatrick, and Sober
Langley
et al.
Maize
et al.
Dewan and Ackerman
Farmer and Hood
Conclusion
SEE ALSO
-
melanoma
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Smith
"The principal histologic criterion for the diagnosis [of melanoma] is the presence of dermal invasion by atypical melanocytic cells (melanoma cells) from the overlying epidermis. In most tumors, the atypical cells within the epidermis are arranged in nests or clusters at the epidermal-dermal junction; however, individual cells or a row of cells may be present. If the cells are confined to the epidermis, but show definite atypical cytologic features, the designations atypical junctional nevus and melanoma
in situ
are used. Not until the atypical cells have actually invaded the dermis is the lesion diagnosed as a malignant melanoma."
Smith Jr JL. Pigmented nevi and malignant melanoma. In: Graham JH, Johnson WC, Helwig EB.
Dermal Pathology.
Maryland: Harper and Row Publishers, Inc., 1972:491.
Brief Critique
As mentioned already, the notion of invasion being recognizable morphologically is fallacious. The phrase "atypical junctional nevus" does not convey anything meaningful, especially in the context of that nevus being employed as a synonym for melanoma in situ. The other findings mentioned by Smith are of no assistance in coming to a specific diagnosis of melanoma, all of them being noted not uncommonly in Spitz's nevi.
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