< 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.
"Any change from the normal appearance is an indication for excision and histological examination. Malignancy should be suspected when a mole shows:
(a) Increased size.
(b) Increased depth of pigmentation and its extension into the surrounding skin.
(c) Crust formation or bleeding.
(d) An inflammatory areolar around the mole." (
Sneddon IB, Church RE.
3rd Edition. London: Edward Arnold (Publishers) Ltd., 1976:196.
Fig. 6 Our diagnosis and comment: Melanoma. The entire neoplasm pictured here, that is, the patch, plaque, papules, nodule, and tumor, represent a single pathologic process at different stages in the development of it, namely, melanoma. It is not a "melanoma arising in a senile freckle," but a melanoma
. A so-called senile freckle, known also, erroneously, as Hutchinson's melanotic freckle, precancerous circumscribed melanosis of Dubreuilh, and lentigo maligna actually is a melanoma
on skin, usually of the face, damaged badly by sunlight. The entire neoplasm shown here is a melanoma because it is asymmetrical, has a notched border, has an uneven surface, and is variegate in color.
What is said, conventionally, to be a mole transforming into melanoma actually is an evolving melanoma that arose
. Less than 20% of melanomas in Caucasians begin in asssociation with a pre-existing melanocytic nevus. A morphologist, looking for the first time, cannot appreciate an increase in size or an increase in depth of pigmentation; that information can be gleaned only by history or through photographs taken over time. By the time there is "crust formation or bleeding" and "an inflammatory areola around the mole," it is likely that the melanoma has metastasized.
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