Fitzpatrick, Milton, Balch, Shaw, McCarthy, and Sober

 
"Hallmarks [clinically of malignant melanoma] are (1) variegation in color; (2) an irregular, raised surface; (3) an irregular border with indentations; and (4) ulceration of the surface epithelium. These features are generally distinct from those seen in most benign acquired nevi. Not all melanomas are pigmented; perhaps 5% to 10% are amelanotic nodules that are diagnosed as melanomas by a pathologist upon biopsy. An irregular, raised surface may develop with a "tabletop," "dome," or "polypoid" configuration. Loss of skin markings is a late sign of melanoma. Irregular borders develop either because of uneven radial (lateral) growth or because of partial spontaneous regression.
 
Early lesions have a macular (flat) or plaque (slightly raised) configuration. This morphology represents the radial growth phase of cutaneous melanoma in which the malignant cells have penetrated into the papillary dermis but not any deeper. The possibility of metastasis is low at this time. Vertical growth is associated with nodule development within the lesion. Increase in height, deeper penetration within the dermis, and increased capacity to metastasize occur simultaneously.
 
Fitzpatrick TB, Milton GW, Balch CM, Shaw HM, McCarthy WH, Sober AJ. Clinical Characteristics. In: Balch CM, Houghton AN, eds. Cutaneous Melanoma. 2nd Edition. Philadelphia: J.B. Lippincott Company, 1992:226.
 

Brief critique

 
The hallmarks for clinical diagnosis of melanoma set forth by Fitzpatrick et al. in 1992 are of little help to a physician who seeks to diagnose melanoma at a stage when it is still curable. By the time there is ulceration, loss of skin markings, and a nodule, the neoplasm usually has metastasized. Fitzpatrick and coworkers present no criteria for identification of "early lesions of melanoma." Moreover, despite the repeated use of "irregular" for surface and border characteristics of melanoma, the term is not defined by them, and, therefore, is but another cliché in the lexicon of melanocytic neoplasia, along with "suspicious," "funny-looking mole," and the "ABCDs."