< 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.
"They [malignant melanomas] do not occur before puberty. Signs of commencing malignancy are sudden spread, especially with a halo of pigmentation outside the lesion, change in colour, the lesion usually becoming jet black, but sometimes becoming skin coloured, irritation [sic] or friability. A malignant melanoma arising in normal skin is usually a glistening, jet black colour, but can occasionally be skin-coloured." (
Roxburgh's Common Skin Diseases.
14th Edition. London: H.K. Lewis & Co. Ltd., 1975:389.
Fig. 5 Our diagnosis and comment: Melanoma. What is called a "senile lentigo" in figure 212 has nothing to do with senility or old age and is not a lentigo of any kind, such as, simple, solar, PUVA, "ink spot," labial, etc. It is a melanoma because it is asymmetrical, has a notched and scalloped border, has a markedly uneven surface, is variegate in color, and, in one locus, is ulcerated and crusted.
Melanomas surely occur before puberty and when they do are often very thick, involving not only the entire dermis but much of the subcutaneous fat. Those neoplasms in prepubescent children metastasize and, in time, prove fatal.
It is not true, too, that "commencing malignancy" of melanoma is signaled by "sudden spread." In reality, macules of melanoma grow in turtle-like fashion. What is called "a halo pigmentation outside the lesion" is not the "halo phenomenon," but regression of a different kind and peculiar to melanoma. Although melanoma does change in color, only uncommonly is it "jet black." It is not correct to state that melanoma "arising in normal skin is usually a glistening, jet black color . . ."; usually it is not jet black.
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