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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.
"Table 3.2 Danger signs of melanoma
Increase in size of pre-existing mole or development of new pigmented lesion
Irregular outline developing in pre-existing mole or presence of this feature in new pigmented lesion
Irregular degree of pigmentation (variegation) in pre-existing mole or this feature in new pigmented lesion
Irritation, soreness, inflammation, crusting, erosion, bleeding in pre-existing mole or in new pigmented lesion"
United Kingdom: Martin Dunitz Ltd., 1992:55.
Two of the four "dangerous signs of melanoma," according to Marks, are dependent on history provided by a patient rather than on morphologic observation by a physician, namely, "increase in size" and "irritation, soreness, inflammation . . ." of a pigmented lesion. The crucial findings for identification of melanoma by a patient should be no different than those utilized by a physician. Those signs, by definition, must be morphologic, rather than anecdotal. Terms like "irregular outline" and "irregular degree of pigmentation" are vague and imprecise. By the time that there is "crusting, erosion, bleeding" of a melanoma, the prognosis is markedly unfavorable; metastases probably have occurred.
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