< 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.
Roses, Harris, and Ackerman
"Early in their evolution, primary cutaneous malignant melanomas are virtually always clinically flat and characterized by asymmetry and poor circumscription; that is, the pigmented lesion has an irregular, scalloped, or notched periphery. When these lesions first begin to form, they may not be detectable at all. By the time they are noticed by the patient or by a physician, they usually measure more than 6 mm. in greatest diameter. Flat lesions of malignant melanoma are also characterized clinically by variation in color, namely, hues of brown from faint tan to deep brown. There may even be foci that are black or bluish." (
Roses DF, Harris MN, Ackerman AB.
Diagnosis and Management of Cutaneous Malignant Melanoma.
Philadelphia: W.B. Saunders Company, 1983:27.
Fig. 8 Our diagnosis and comment: Melanoma. The three melanomas shown here can be inferred to be
because they are flat, but just because a melanoma is flat does not mean that it is "early;" a patch of melanoma may be many centimeters in diameter and, therefore, more than a score of years old. For that reason, it is preferable to characterize every melanoma morphologically, to wit, macule, patch, papule, plaque, nodule, and tumor, rather than as being "early" and "late."
The emphasis in these lines written in the monograph by Ackerman is the same as in those by him in 1981, namely, signs of melanoma early in its course when it is small and flat. Then, as in 1983, the word "irregular" for the periphery of a melanoma was imprecise and the number 6 mm for diameter of melanoma was misleading, ill-conceived, and erroneous; no number is important in diagnosis of melanoma, clinically or histopathologically. The diagnosis must be made on the basis of morphologic signs, such as asymmetry, notched border, and mottled pigmentation.
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