Roses, Harris, and Ackerman

 

"The histological diagnosis of malignant melanoma is based upon both architectural pattern and cytological features, which may be summarized as follows:

 
Architectural Pattern:
 
  1. Relatively large lesion (more than 6 mm. in greatest diameter)
  2. Asymmetry
  3. Poor circumscription
  4. Failure of maturation of melanocytes with progressive descent into the dermis
  5. Nests of melanocytes variable in sizes, irregular in shapes, and tending toward confluence
  6. "Buckshot scatter" of melanocytes throughout the epidermis
  7. Melanocytes within the epithelial structures of adnexa
 
Cytological Features:
 
  1. Atypical melanocytes
  2. Melanocytes in mitosis
  3. Necrotic melanocytes
 
In addition to these criteria for the histologic diagnosis of malignant melanoma, there are also adjunctive clues for diagnosis, which are listed as follows:
 
Adjunctive Clues:
 
  1. Signs of severe solar elastosis
  2. Melanocytes in mitosis near the base of the neoplasm
  3. Abundant melanin in melanocytes near the base of a neoplasm
  4. Signs of regression of parts of the lesion, that is, fibrosis and/or marked melanosis in a thickened papillary dermis
  5. Patchy, uneven distribution of melanin within the neoplasm
  6. Satellite neoplastic melanocytes (a sign of local metastasis)
  7. Melanocytes within vascular lumina
  8. Presence of plasma cells
  9. Single melanocytes predominate over nests of melanocytes in the epidermis
  10. Presence of melanocytes with pagetoid morphology."
 
Roses DF, Harris MN, Ackerman AB. Diagnosis and management of cutaneous malignant melanoma. Philadelphia: WB Saunders Co., 1983:35–37.
 

Brief Critique

 
Criteria that employ architectural pattern and cytologic features in conjunction with adjunctive clues enabled greater efficacy of the system being developed by Ackerman for specific diagnosis of melanoma. Also added to the criteria are asymmetry and predominance of single melanocytes over nests of melanocytes in some high power fields within the epidermis. The number 6.0 mm for diameter has no merit; all melanomas were once smaller than that. The word "irregular" is unhelpful and melanocytes as solitary units and in nests are expected findings in various kinds of nevi, as well as in melanomas. The distribution of those melanocytes is very different in nevi and melanomas.