Historical Perspective: Spitz, 1951; Pack and Scharnagel, 1951

 
Despite these statements by her husband, who not only worked with her closely, but was dependent on her professionally,** Spitz, by 1951, continued to regard "juvenile melanoma" as malignant. In an article about "Cutaneous tumors of childhood: Disparity between clinical behavior and histologic appearance,"9 she summarized much of what she had stated in 1948 in this way:
 
"In the records of Memorial Hospital, 13 of those 'juvenile melanomas' have been found and only in one from the sole of the foot in a female of twelve years was the outcome fatal. Other cases too have been reported in children, in which there were recurrences and even metastases with survival, nonetheless, for many years . . . In a few instances, multinucleated giant cells are found that seem to occur more often in children than in adults. This structure occurring in melanomas after puberty has been associated with the most grave prognosis, but in children the clinical course has rarely been that of a malignant tumor."
 
Spitz persisted in theorizing that absence of sex hormones was responsible for the benign behavior of melanomas of childhood, and she persisted, too, in considering it to be malignant, as these words of hers attest:
 
"An explanation of this remarkable disparity between the histologic appearance and the clinical course of melanomas in children has been postulated on the basis of hormonal control of melanomas. There must exist during childhood a hormonal inhibition to the fatal spread of melanomas."
 
In 1951, Pack, together with Scharnagel, wrote about the disparity between the histopathologic appearance of pre-pubertal melanomas and the biologic behavior of them.10 As preamble to that subject, the coworkers set forth anew their opinion about melanomas that occurred in infancy and children, and about the effect of hormones on the clinical course of them. This is what they said:
 
"In tracing the end results of treatment of the melanomas of infancy and childhood, we were long ago impressed by the obvious fact that these children were uniformly cured often by simple conservative excision and that the melanoma in subjects of this age might be microscopically indistinguishable from its malignant prototype, yet it is clinically benign. In the course of our experience with more than 1050 verified cases of malignant melanoma, we have never observed a single instance in which a melanoma of infancy or childhood metastasized to nodes and viscera and we have never witnessed a fatal outcome. There have been rare exceptions to this statement in other people's experience, but our investigations of reputed cases available for our personal study have strengthened our position concerning the rarity of true malignancy in this tumor. We have suggested the term 'pre-pubertal melanoma' for these deeply pigmented tumors that bear the histological earmarks of the malignant melanoma yet do not metastasize nor cause death. The distinction here has to do solely with the age or rather the endocrine status of the patient."
**After Spitz died on August 11, 1956, Allen went from being inordinately prolific to nearly abstemious.