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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.
Sulzberger and Wolf
"The malignant mole is one of the most serious lesions we [physicians] are called upon to treat. Often metastasis has taken place before the physician is consulted. The outlook is bad, if not invariably fatal. If small, early lesions are excised in toto, with a wide margin, some cases will be cured. . ."
"Malignant melanomas are usually heavily pigmented, bluish to black, rapidly growing tumors."
Sulzberger MB, Wolf J.
Dermatology Essentials of Diagnosis and Treatment.
Chicago: The Year Book Publishers, Inc., 1952:385.
The term "malignant mole" is an oxymoron; a mole is a colloquial expression employed by the laity and by indiscriminant physicians for a melanocytic nevus, and a melanocytic nevus, by definition, is benign. In short, a melanoma is not a malignant mole. According to Sulzberger and Wolf, on the basis of their experience prior to 1952, when patients with a primary melanoma present themselves to a physician, the neoplasm already had metastasized and the "outlook is bad, if not invariably fatal." They understood, properly, that if "small, early lesions are excised in toto . . . some cases will be cured . . ." In fact, all macules of melanoma that are devoid of signs of regression are curable by simple excision with a narrow margin. Never is a "wide margin" necessary for removal of melanoma, irrespective of the thickness of it; excision
is what is necessary.
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