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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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Domonkos, Arnold, and Odom
"At first atypical, but still dendritic, melanocytes are found at the dermoepidermal junction. These melanocytes are anaplastic or hyperplastic and contain vacuolated cytoplasm. Pinkus has emphasized the characteristic features of their nucleus: dark-staining and folded, not vesicular as in a junction nevus. As the melanocytes proliferate, the dermoepidermal border becomes irregular, while the melanocytic cells may form nests at the junction to give them a moth-eaten appearance. These atypical cells retain the cytologic features of melanocytes; they never become nevus cells. As the invasion extends into the dermis, an invasive melanocytic[sic] melanoma develops and metastasis is a possibility, though unlikely until a nodule is formed, as Hirsch and Helwig have long emphasized."
Domonkos AN, Arnold Jr. HL, Odom RB.
Andrews' diseases of the skin.
7th Edition. Philadelphia: WB Saunders Company, 1982:863.
Brief Critique
This description is replete with error, among them violations of fundamental precepts of pathology (
e.g.,
hyperplasia rather than neoplasia), abstruse imagery (
e.g.,
moth-eaten appearance), animistic interpretation (e.g., invasion), and misconception (
e.g.,
nevus cells). Nothing stated by these authors permits a histopathologist to make a specific diagnosis of melanoma with surety.
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