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Dermatopathology: Practical & Conceptual July - September 2001
Evolution in Thinking: Criteria for Clinical 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
Sulzberger and Wolf
Pillsbury, Shelley, and Kligman
Fitzpatrick and Clark
Lewis and Wheeler
Callen, Stawiski, and Voorhees
Roses, Harris, and Ackerman
Dobson and Abele
Friedman, Rigel, and Kopf
Fitzpatrick, Rhodes, Sober, and Mihm
Koh and Rogers
McCarthy et al.
Mooi WJ and Krausy
Fitzpatrick, Milton, Balch, Shaw, McCarthy, and Sober
National Institutes of Health Consensus Conference
Holzle, Kind, Plewig, and Burgdorf
Marghoob, Slade, Kopf, Rigel, and Friedman
Arndt, Wintroub, Robinson, and LeBoit
Elder and Elenitsas
Maize et al.
Langley, Fitzpatrick, and Sober
Farmer and Hood
Fleischer, Feldman, Katz, and Clayton
Ackerman, Kerl, Sánchez, et al.
Becker and Obermayer
"When arising from normal skin, a macule [of malignant melanoma] appears which is at first brownish, but soon becomes darker in color and later changes into a nodule. The lesion grows to form a tumor which is often lobulated." (
Becker SW, Obermayer ME.
Modern Dermatology and Syphilology.
2nd Edition. Philadelphia: J.B. Lippincott, 1947:706.
Fig. 1 Our diagnosis and comment: Melanoma. This melanoma, characterized by a notched border and an uneven surface, is a nodule and, therefore, is nearer to being 10 years old, rather than to being of "one year's duration."
Becker and Obermayer rightly understood that, for practical purposes, all primary cutaneous melanomas begin as a "brownish" macule, but they fail to communicate that only very gradually does it become "darker in color" and only very slowly, over the course of years, does it evolve into a patch, a papule, or a papule on a patch. Never does a macule, which is the clinical analogue of melanoma
develop directly into a nodule, that is, the so-called vertical growth phase that Clark claimed was characteristic from the outset of "nodular melanoma." By the time that a nodule of melanoma has formed, the melanomatous process usually has been underway for about a decade.
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