< Current issue
Dermatopathology: Practical & Conceptual January - March 2006
5. New Heights: An assist to the next (10th) edition of “Lever’s”
Renata A. Joffe, M.D.
1. Small plaque parapsoriasis
2. Dysplastic nevus
3. Solar keratosis
4. Inverted follicular keratosis/trichilemmoma
5. Discoid lupus erythematosus vs. systemic lupus erythematosus
6. Lentigo maligna
7. Atopic dermatitis
8. Sebaceous adenoma
9. Muir-Torre syndrome
10. Bowen’s disease
11. Follicular mucinosis/alopecia mucinosa
12. Granuloma faciale and erythema elevatum diutinum
13. Follicular degeneration syndrome
14. Eccrine papillary adenoma
15. Degos’ disease
17. Proliferating tricholemmal cyst
18. Erythema multiforme (dermal and epidermal types)
19. Lichen sclerosus et atrophicus vs. morphea
20. Malignant melanoma (classification)
21. Malignant melanoma—ABCD’s
22. Malignant melanoma—wide/deep excision
23. Sentinel node biopsy for melanoma
24. Malignant melanoma: nontumorigenic compartment of primary malignant melanoma (radial growth phase), tumorigenic compartment of primary malignant melanoma (vertical growth phase)
25. Minimal deviation melanoma
26. Nevoid melanoma
27. Malignant melanoma—in infancy and childhood
28. Malignant blue nevus
29. MELTUMP and SAMPUS
30. Bulge activation hypothesis
29. MELTUMP and SAMPUS
Quotation from the 9th edition of Lever's:
"This is a descriptive term for a heterogeneous group of melanocytic tumors that exhibit some features indicative of possible malignancy, such as nuclear atypia, macronucleoli, mitotic activity, necrosis, or ulceration, but in number or degree insufficient to justify a malignant diagnosis. Accordingly they reflect the biological reality that occasional melanocytic lesions that do not meet criteria for fully evolved melanoma cannot be predicted to be benign with 100% accuracy."
"Not all superficial melanocytic proliferations can reliably and reproducibly be distinguished as either a superficial melanoma or as a nevus. In such cases, we provide a descriptive designation, such as 'superficial atypical melanocytic proliferation of uncertain significance' ('SAMPUS'), with a differential diagnosis."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Melanocytic tumor of uncertain malignant potential (MELTUMP). A phrase coined by David Elder and used by him, his co-workers, and followers of them for diagnosis of a "category" that "is comprised of melanocytic proliferations that form tumours in the dermis, and are therefore potentially capable of metastasis." For Elder et al., "Examples of such lesions may include atypical Spitz naevi, deep penetrating naevi, possible naevoid melanomas, or cellular blue naevi, where because of increased mitotic activity or cytologic atypia, a diagnosis of invasive or tumorigenic melanoma cannot be ruled out." Because MELTUMP is as unfathomable and as unuseful as SAMPUS (superficial atypical melanocytic proliferation of uncertain significance), another acronym spawned by Elder et al., it is best discarded now before a foothold is gained in the lexicon of general pathology and dermatopathology."
"Superficial atypical melanocytic proliferation of uncertain significance (SAMPUS). A phrase employed for diagnosis by David Elder, his associates, and followers of them to designate a "category" that "includes predominantly junctional melanocytic proliferations, and melanocytic proliferations that are confined to the epidermis and papillary dermis, without evidence of tumorigenic proliferation or mitotic activity there." Because the term is generic, rather than specific, it is not a diagnosis precise but a description recondite and, at the same time, an acknowledgment of doubt about behavior biologic, adding nothing to what should be an effort mighty to arrive at a diagnosis precise and to an understanding profound of melanocytic neoplasia. Now is the time to jettison the fuzzy phrase before it becomes yet another example of gobbledygook incorporated in the language of general pathology and dermatopathology."
Ackerman AB, Elish D, Shami S. "Spitz's nevus": Reassessment critical, revision radical. New York: Ardor Scribendi, 2005.
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