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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 majority of melanomas do not present any difficulty in diagnosis, either clinically or histologically. Patients usually seek attention when a mole or "birth mark" is enlarging or bleeding. In order of frequency, the first symptoms noticed by patients are an increase in size, a color change, bleeding, and itching."
Melanoma: Histological Diagnosis and Prognosis.
New York: Raven Press, 1983:100.
By the time that patients note bleeding of a "mole" or "birthmark," the melanoma probably has metastasized. The emphasis of McGovern is on "symptoms noticed by patients," rather than on morphologic signs identifiable by clinicians. In brief, as recently as 1983, what authors stressed for diagnosis of melanoma are signs and symptoms that patients call to the attention of physicians, rather than on morphologic findings physicians can recognize in lesions that are small and flat, and, therefore, curable.
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