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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.
"The lesion is usually deeply pigmented and in those arising from a pre-existing cellular naevus the first change may be an irregularity in pigmentation of the lesion. Pigment may then spread laterally from the naevus to produce an irregular blotchy halo of pigmentation. The lesion becomes thicker and may bleed readily.
On normal skin the lesion may appear as a pigmented nodule which rapidly ulcerates and invades the dermis. Sometimes the malignant cells invade laterally producing a macular pigmented lesion or a slightly raised plaque."
Meara RH. Epithelial and melanocytic tumours of the skin. In: Marks R, Samman PD, eds.
New York: Appleton-Century-Crofts, 1977:102.
A macule of melanoma that develops
is not usually deeply pigmented and a macule that comes into being in association with a pre-existing melanocytic nevus evolves in the same manner as does a melanoma that arises
. There are no differences between them in clinical appearance, except for those in which the pre-existing nevus is still obvious, having not yet been overrun by the abnormal melanocytes of melanoma. By the time that a melanoma is sufficiently thick to "bleed readily," metastases from it in all likelihood have occurred. A melanoma, whether it arises
or in conjunction with a nevus, begins as a macule and not "as a pigmented nodule which rapidly ulcerates and invades the dermis."
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