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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 [malignant melanoma] is usually but not always pigmented. If any of the following features are reported then malignant melanoma should be suspected:
(a) Increase in size of a pigmented lesion. There may also be satellite pigmented lesions.
(b) Alteration in pigmentation of the lesion. The skin surrounding the lesion may also show alteration of pigmentation, either increased, or decreased.
(c) Ulceration or bleeding of a pigmented or non-pigmented lesion."
Dermatology, An Illustrated Guide.
London: Update Publications Ltd., 1978:967.
The three criteria set forth by Fry are not helpful to a clinician who seeks to diagnose a curable lesion of melanoma. Increase in size and alteration of pigmentation are information derived either from history or examination of photographs taken serially, not by a single assessment morphologically by a clinician. By the time ulceration or bleeding has occurred, the melanoma usually has metastasized.
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