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< Current issue
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.
Introduction
Becker and Obermayer
Ormsby and Montgomery
Lever
Sulzberger and Wolf
Pillsbury, Shelley, and Kligman
Fitzpatrick and Clark
Lewis and Wheeler
Wayte
Domonkos
Sanderson
Borrie
Clark
Sneddon
Meara
Fry
Sauer
Callen, Stawiski, and Voorhees
Roenigk
Ackerman
McGovern
Roses, Harris, and Ackerman
Dobson and Abele
Ackerman
Ackerman
Friedman, Rigel, and Kopf
Fitzpatrick, Rhodes, Sober, and Mihm
Koh and Rogers
McCarthy et al.
Habif
MacKie
Marks
Mooi WJ and Krausy
Fitzpatrick, Milton, Balch, Shaw, McCarthy, and Sober
National Institutes of Health Consensus Conference
Levine
Holzle, Kind, Plewig, and Burgdorf
Moynihan
Epstein
Marghoob, Slade, Kopf, Rigel, and Friedman
Arndt, Wintroub, Robinson, and LeBoit
Elder and Elenitsas
Barnhill
Maize et al.
Langley, Fitzpatrick, and Sober
Sagebiel
Farmer and Hood
Fleischer, Feldman, Katz, and Clayton
Ackerman, Kerl, Sánchez, et al.
References
SEE ALSO
-
melanoma
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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." (
Fig. 1
)
Becker SW, Obermayer ME.
Modern Dermatology and Syphilology.
2nd Edition. Philadelphia: J.B. Lippincott, 1947:706.
View Figure
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."
Brief critique
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
in situ,
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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