< 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.
"A number of clinical characteristics can aid in the recognition of early melanoma. These have been summarized by the American Cancer Society as the
s of melanoma.
represents asymmetry . . ."
" stands for border. Borders of benign lesion are regular, without notches or peninsulas, and they are well-defined, without any "water-color wash" or "bleeding" of pigment into the surrounding skin.
" refers to color . . . Warning signs relating to color include variation in color within a lesion, surrounding erythema, hypopigmentation, or significant variation in color among nevi on the same patient.
" stands for diameter. Most benign lesions are less than 6 mm in diameter.
" might be added to the
s for a changing or asymmetric elevation.
Not all of the
danger signs need to be present to make a lesion worrisome. A single characteristic may cause enough suspicion to warrant a biopsy. On the other hand, dysplastic nevi often have some positive
characteristics, such as two-tone color or a peripheral macular and central papular component, which can raise suspicion of early melanoma in the context of this system of evaluation . . . Evidence of change in a pigmented lesion is probably the single most important clinical characteristic that suggests a need for biopsy."
Sagebiel R. Clinical Presentation. In: Miller SJ, Maloney ME.
USA: Blackwell Science, Inc., 1998:254.
Sagebiel, in the tradition of trainees of Harvard University-University of Pennsylvania concerning melanocytic neoplasia (he trained in general pathology and dermatopathology with Clark before Clark left Harvard for Penn), puts forward in conventional fashion the ABCDEs as "clinical characteristics" that can "aid in the recognition of early melanoma." As has been stated many times previously in the series of "Brief Critiques," E for Elevated is not a sign of early melanoma; F for Flat is.
Sagebiel states that "dysplastic nevi often have some positive ABCD characteristics;" in fact, Kopf and his coworkers have advised repeatedly that the same ABCDs that first were utilized for identification clinically of melanoma are applicable equally to diagnosis clinically of dysplastic nevi. That concept, of course, is incomprehensible because it is illogical and therefore devoid of legitimacy. How can a benign neoplasm, that is, a dysplastic nevus, have the very same clinical features as a malignant neoplasm, that is, a melanoma. That kind of illogic during the past 40 years has made melanocytic neoplasia the consummate example of pathobabel.
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