< 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.
"The diagnosis of melanoma is usually based on the clinical appearance of a pigmented lesion in addition to a history of recent change, the latter being the most important clue. The following clinical criteria suggest the possibility of melanoma.
A change in the surface area of a nevus. Sudden enlargement.
A change in elevation of a lesion, with a flat mole becoming raised, palpable, nodular, or thickened.
A change in color, especially when brownish pigmentation becomes black.
A change in surface characteristics whereby a previously smooth cutaneous surface may become brown and scaly, with or without the occurrence of serous discharge or bleeding after minor trauma.
A change in sensation, e.g. the development of itching or tingling in an area of pigmentation.
A change in surrounding skin with signs of inflammation or appearance of satellite pigmentations."
Roenigk HH Jr.
Baltimore: Williams & Wilkins, 1981:220.
All six "changes" referred to by Roenigk are beyond the capability of a morphologist to identify on the basis of a single examination ; those "changes" are derived from history or from photographs taken sequentially. In short, even though "clinical criteria suggest the possibility of melanoma," it still is only a possibility; they do not permit a morphologist to make that diagnosis with confidence.
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