< 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 clinical and histologic criteria for identifying macules and patches of malignant melanoma are now firmly established and complete conservative surgical excision of such lesions assures cure of them. Clinically, macules of malignant melanoma are small (less than 1 cm in greatest diameter), flat, asymmetric, poorly circumscribed lesions that have scalloped, notched, or jagged borders that are not uniformly brown but are multicolored, especially by nuances of brown, namely, tan, fawn, and chocolate, and sometimes by black, blue, and pink . . ."
"It probably takes many months of proliferation of these melanocytes before the smallest and flattest of malignant melanomas can be visualized by inspection with the naked eye. It probably takes years before such a flat lesion of melanoma is broad enough (5 or 6 mm) to be diagnosed as a malignant melanoma with reasonable certainty . . ."
No one should die of malignant melanoma.
J Am Acad Dermatol; 1985;12:1156.
The emphasis here, once again by Ackerman, is on flat lesions of melanoma that can be cured by simple excision. Macules, by definition, are less than 1 cm in greatest diameter, and when the lines just quoted were written in 1985, criteria for clinical diagnosis of macules of melanoma were not as refined as they are today. At that time, a melanoma had to achieve a diameter of about 5 or 6 mm before it could be diagnosed for what it was with reasonable certainty; now the diagnosis can be achieved when a macule of melanoma is less than that.
Although it is true that macules of melanoma may be mottled by shades of brown, such as "tan, fawn, and chocolate," only very episodically is a macule of melanoma marked by "black, blue, and pink."
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