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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.
"Any pigmented lesion that can be covered by the unused eraser of an ordinary yellow pencil is likely to be benign or a curable form of malignant melanoma (except for the uncommon nodular melanoma). Concentrate on those lesions larger than the eraser (7 mm)."
Clark WH Jr.
Clinical diagnosis of cutaneous malignant melanoma.
The idea that a "pigmented lesion" less than 7 mm in diameter is "benign or a curable form of malignant melanoma" is specious. Nearly always, primary cutaneous melanomas begin as a macule that is much smaller than 7 mm in diameter. Moreover, melanomas, except for those rare examples in prepubescent children, do not evolve in a fashion analogous to Athena springing from the brow of Zeus; they begin as a tiny macule that grows remarkably slowly. Clinicians should not concentrate on pigmented lesions larger than 7 mm, but on ones that are flat of any size, no matter how small or how large. When a melanoma is flat and without signs of regression, it is curable by simple excision.
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