Ackerman and Su

 

"Histologic Criteria for the Diagnosis of Malignant Melanoma

 
Architectural Pattern
 
Increased number of atypical melanocytes, singly and/ or in nests within the epidermis.
Horizontal extension of atypical melanocytes, singly and/or in nests, within the epidermis beyond the bulk of the intraepidermal and intradermal components of the neoplasm.
Failure of nuclei of the atypical melanocytes to become smaller with progressive descent into the dermis.
Atypical melanocytes present singly and/or in nests at all levels of the epidermis, even including the cornified layer.
Variation in size and shape of intraepidermal and intradermal nests of atypical melanocytes.
Confluence of the nests of atypical melanocytes within the epidermis and the dermis.
Extension of atypical melanocytes, singly and/or in nests, down epithelial structures of adnexa, namely, hair follicles and eccrine sweat ducts.
 
Cytologic Features
 
Atypical melanocytes with large, hyperchromatic, pleomorphic nuclei and prominent nucleoli.
Melanocytes in mitosis within the epidermis and the dermis.
Necrotic melanocytes." (Fig. 8)
 
Ackerman AB and Su WP. Histopathology of cutaneous malignant melanoma. In: Kopf AW, Bart RS, Rodriguez-Sains RS, Ackerman AB. Malignant Melanoma. New York: Masson Publishing USA, Inc.,1979:69.

View Figure  		Fig. 8  Our diagnosis and comment: Melanoma in situ. It is preferable to describe the presence of abnormal melanocytes at all levels of the epidermis as "pagetoid pattern," rather than as "'buckshot' scatter."
 

Brief Critique

 
Although these criteria probably were the most effective of those proposed until that time for specific diagnosis of melanoma, not included among them are important attributes of melanoma, such as asymmetry and predominance of melanocytes disposed as solitary units over nests of melanocytes in some high power fields within the epidermis and within epithelial structures of adnexa. Furthermore, some of the findings listed are seen also in some nevi, like involvement of the upper reaches of the epidermis and of epithelial structures of adnexa by atypical melanocytes in some examples of Spitz's nevus.