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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.
"Gross morphologic features of melanoma includes size often greater than 1 cm (range 2 mm to greater than 15 mm); irregular or notched borders; asymmetry; complexity of color including a variable admixture of tan, brown, blue, black, red, pink, gray, and white; and ulceration and bleeding. Early melanomas especially those involving sun-exposed and acral sites may be completely flat but with progression usually develop a papular or nodular component."
Textbook of Dermatopathology.
New York: McGraw-Hill Companies Inc., 1998:573.
What Barnhill states in these lines is mere variation on the theme of the ABCDs, albeit in a different order, employing a range of 2 mm to greater than 15 mm, and adding to them ulceration and bleeding. The latter are not signs of "early melanoma," but are indicative of likelihood of metastasis having already occurred. It also is not true that only "early melanomas especially those involving some exposed and acral sites may be completely flat;" as a general rule, all melanomas on all anatomic sites begin flat, that is, as a macule.
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