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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.
Becker and Obermayer
Ormsby and Montgomery
Percival, Montgomery, and Dodds
Pinkus and Mehregan
Clark and Mihm
Price, Rywlin, and Ackerman
Pinkus and Mehregan
Ackerman and Su
Kamino and Ackerman
Domonkos, Arnold, and Odom
Roses, Harris, and Ackerman
Okun, Edelstein, and Fisher
Weedon and Strutton
Elder and Elenitsas
Langley, Fitzpatrick, and Sober
Dewan and Ackerman
Farmer and Hood
"Most tumours [of melanoma] show proliferating atypical melanocytes at the dermal-epidermal junction. In superficial and early lesions this is the main change [sic], in large ulcerating tumours it may be seen only in small areas around the ulcer. Malignant cells may invade the epidermis and be shed in the stratum corneum, extend laterally along the junction to produce a melanotic halo, or downwards as an invasive tumour."
"Early and superficial malignant melanoma may closely resemble an active junctional or compound naevus. The cells are usually larger, with more darkly stained nuclei, increased mitoses and, most characteristically, particles of melanin dispersed through the cytoplasm to give a ground-glass appearance."
) Sanderson KV. Tumours of the skin. In: Rook A, Wilkinson DS, Ebling FJG.
Textbook of dermatology.
2nd Edition. Great Britain: Blackwell Scientific Publications, 1972:19812.
Fig. 7 Our diagnosis and comment: Melanoma. The photomicrograph, which is out of focus, shows a melanoma that at least is in situ. Some neoplastic melanocytes may be present amidst the infiltrate of lymphocytes in the upper part of the dermis. The term "melanotic freckle" fails to communicate that the neoplasm truly is a melanoma. Moreover, the atypical melanocytes within the epidermis cannot be seen "proliferating at the junction;" no movement of cells can be detected through a microscope!
All of the changes alleged by Sanderson to be relevant to diagnosis of melanoma are seen in some lesions of Spitz's nevus. His ideas of "active" nevi, invasive tumour, and malignant cells, as judged morphologically, are flawed.
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