< 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.
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.
Fitzpatrick and Clark
"Table 2. Clues to the Early Diagnosis of Malignant Melanoma
History: Recent onset, recent growth or darkening of so-called mole
Color: Variegated color pattern, black and tan
Configuration: Irregular, geographic, spreading border"
Fitzpatrick TB, Clark WH Jr. Problems in the Diagnosis of Malignant Melanoma. In:
Tumors of the Skin.
Chicago: Year Book Medical Publishers, Inc., 1964:173.
Melanoma, whether it begins
or in association with a pre-existing melanocytic nevus, develops at first at a petty pace, which means that it remains macular for years. At the very outset, melanoma surely is not visualizable clinically and once it becomes visible, abnormal melanocytes of it proliferate for years in the confines of epidermal and adnexal epithelium, during which time the lesion is flat. It is impossible to predict for how long a melanoma will remain macular (
histopathologically), but a broad patch of melanoma is testimony to the process having remained
for several decades. It may seem to a patient that a lesion of melanoma is of recent onset and has undergone recent growth (in fact, the two most common refrains of patients in regard to their melanoma is that it either "has been there all my life" or "it just appeared"), but, in actuality, that never is the case. When a melanoma is very small and flat, the color may not be variegate and rarely is it black. As a rule, a tiny macule of melanoma is a relatively uniform hue of brown. Only later does the lesion become variegate, sometimes including dark brown or black. Terms like "irregular," "geographic," and "spreading border" are ill advised because they have not been defined meaningfully; "spreading" is not a morphologic sign but an evidence of biologic behavior. Moreover, in a sense, virtually all primary cutaneous melanomas are at first "superficial spreading," that is, abnormal melanocytes proliferating for years entirely within epidermal and adnexal epithelium.
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