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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.
Koh and Rogers
"The American Academy of Dermatology has stressed the importance of remembering "
" when evaluating any pigmented lesion:
symmetry—the two halves of the lesion are not identical;
order irregularity—scalloped, notched, or poorly circumscribed border;
olor variegation—-melanoma can be pure black, or feature haphazard combinations of red, white, blue, brown, and black;
iameter—-greater then 0.6 cm (the size of a pencil eraser).
The diagnosis of melanoma should always be entertained when a patient reports a new pigmented lesion or a changing mole, such as (1) a change in color, (2) change in size (especially rapid enlargement), (3) development of symptoms (itching, burning, or pain) in a pre-existing mole, (4) development of raised areas in a previously flat lesion (although melanoma can be flat or raised), (5) change in surface (scaling, ulceration, crusting, bleeding) or consistency of a pigmented lesion, or (6) development of satellite lesions."
Koh HK, Rogers GS. Malignant melanoma: Early detection and treatment.
By the late 1980s, the ABCDs had caught on, not only for instruction of patients and medical personnel, but also for physicians, including dermatologists. As has been indicated here repeatedly, the ABCDs not only are simplistic, but often can lead to misdiagnosis of a Clark's nevus, a seborrheic keratosis, a dermatofibroma, or a pigmented basal-cell carcinoma as a melanoma, to mention but a few examples of that pitfall.
Koh and Rogers gave weight to the observations of a patient who "reports a new pigmented lesion or a changing mole," whereas the emphasis really should be on morphologic findings that enable a clinician to come to a diagnosis with specificity. The first five features that Koh and Rogers would have a patient report to a physician, however, concern change in a lesion (change in color, size, feelings, elevation, and surface). "Satellite lesions" are metastases and metastases of melanoma are a sign of grim prognosis, namely, death, in time, as a consequence of them.
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