< 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 goal is to recognize melanomas at the earliest stage. Compared to common acquired melanocytic nevi, malignant melanomas tend to have
olor variegation, and
iameter enlargement. Changes in shape and color are important early signs and should always arouse suspicion. Ulceration and bleeding are late signs; hope of cure diminishes greatly if the diagnosis has not been made before such changes occur . . ." (
Clinical Dermatology A Color Guide to Diagnosis and Therapy.
2nd Edition. St. Louis: The C.V. Mosby Company, 1990: 5645.
Fig. 9 Our diagnosis and comment: Melanoma. Although this melanoma is situated on an acral part, that does not make it "acral-lentiginous melanoma." Irrespective of the anatomic site, the neoplasm pictured here fulfills criteria clinically for melanoma. If the very same lesion were present on sun-damaged skin of the face, it would be termed "lentigo maligna melanoma," and were it positioned on the trunk it would be designated "superficial spreading melanoma." In brief, melanoma morphologically is melanoma on every anatomic site, including mucous membranes.
Habif is correct to underline the importance of recognizing melanomas "at the earliest stage," and toward that end he advocates the simplistic, and often erroneous, ABCDs. He also tells of the importance of history in the form of "changes in shape and color," information that is much less important for diagnosis than actual morphologic findings. He rightly notes that "ulceration and bleeding" indicate a grave prognosis and, that being the case, are irrelevant to recognizing melanomas "at the earliest stage."
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