Wayte

 
"Malignant melanomas are presented in a multiplicity of disguises, and their appearance may vary from that of exuberant granulation tissue (as is seen with subungual malignant melanomas) to that of other skin tumors, including dermatofibromata, hemangiomata, basal and squamous cell carcinomata and atypical fibroxanthomas. In those lesions in which melanin pigmentation is obvious, the size may vary from a macule less than 5 mm. in diameter to an enormous, fungating, ulcerated lesion surrounded by satellites . . ."
 
" . . . Rapid growth, excessive pigmentation, ulceration, hemorrhage, or local infiltration—any of these changes occurring within a pigmented nevus warrants a clinical diagnosis of malignant melanoma until histologically proven otherwise."
 
Wayte DM. Pathology of Nevi and Melanomas. In: Helwig EB, Mostofi FK, eds. The Skin by 30 authors. Baltimore: Williams and Wilkins, 1971:521.
 

Brief critique

 
By the time that a melanoma simulates "exuberant granulation tissue . . . dermatofibromata, hemangiomata, basal and squamous-cell carcinomata, and atypical fibroxanthomas," almost certainly it has already metastasized. What needs to be emphasized in regard to cure of melanoma is recognition of it as a "macule less than 5 mm in diameter" and not as an "enormous, fungating, ulcerated lesions surrounded by satellites . . ." By the time, too, that there is "rapid growth," ulceration, and hemorrhage of melanoma, the neoplasm is many years old and, almost certainly, has spread through vascular channels to other sites.