Letter to the editor (White and Chen, 2005) and answer to it (Zembowicz, 2005) [14]

At long last, the cat came out of the bag in an answer by Zembowicz to a question posed by White and Chen in a letter to the editor in the August 2005 issue of The American Journal of Surgical Pathology. The subject itself in debate may have little to do with understanding lesions melanocytic, whether pigmented or not, but the importance of it transcends lesions of any kind. This is what Zembowicz wrote: " . . . So why did these distinguished pathologists (Carney and Mihm) agree to change the name of their [emphasis ours] entities (epithelioid blue nevus and animal-type melanoma)? The reason was the emergence of new information presented in our paper. This required a paradigm shift and suggested a change in terminology."

So, in the final analysis, it is conformity with the authority of "distinguished pathologists" that Zembowicz considers reason sufficient for giving obeisance to the idea of pigmented epithelioid melanocytoma. It no doubt was the same submission to authorities well established that motivated the previous "paradigm shifts" from blue nevus to Carney's complex to pilar neurocristic hamartoma to cutaneous malignant melanotic neurocristic tumors arising in neurocristic hamartoma to heavily pigmented melanoma to animal type melanoma and, last, to (at least for the moment) pigmented epithelioid melanocytoma. Taking all this into account, it is certain that the "distinguished pathologists" will ordain more "paradigm shifts" and more "changes in the terminology." The next "paradigm shift" has even been announced in print:

Having been hyposensitized to the concepts kooky of malignant Spitz nevus and malignant blue nevus, the community of pathologists will have no difficulty embracing fervently another pronouncement ex cathedra, namely, malignant pigmented epithelioid melanocytoma, without so much as a peep to the effect that a neoplasm malignant of melanocytes, by definition, is a melanoma and, therefore, pigmented epithelioid melanocytoma modified by the word "malignant" is a redundancy: pigmented melanocytic melanocytoma is synonymous with "animal-type" melanoma; it is melanoma!

Parenthetically, what about the possibility of "establishing the criteria that predict benign clinical behavior"? Will Zembowicz et al. "debate the merit of using the term "benign pigmented epithelioid melanocytoma"? The classification resulting from the "new paradigm" becoming: benign pigmented epithelioid melanocytoma vs pigmented epithelioid melanocytoma (neither benign nor malignant---but not "unknown") vs malignant pigmented epithelioid melanocytoma. Considering such finality to the process, we are at a loss to recognize what improvement is brought by it to the understanding of melanocytic neoplasia; to us, it looks like "beating gums" rather than exerting neurons.

The closing sentences of Zembowicz's letter [15] reinforce his allegiance to the principle of genuflection to the authority in pathology: "The opinion of Medalie and Ackerman regarding sentinel lymph node sampling in melanoma are not the mainstream at this point. However if they turn out to be right, it will change my mind. What would you do?"

Our answer to Zembowicz is simple: "Think! Wait not for the mainstream!" An idea original, a thought critical, an impulse to resist balderdash, no matter from which authority, generates steam and self esteem!

Unfortunately, the story told in the pages of this monograph conveys, undeniably, that what is important for all too many "academicians" is not finding the truth or even searching for it, but being right and, maybe even more, protecting the expert, the "distinguished pathologists," from being shown to be wrong, sometimes dead wrong! It comes to a matter of staying "in the mainstream," behaving in a manner elephantine, trunk to tail and tail to trunk. A game of power and compliance with prevailing authority! It induced revulsion in Galileo and it induces emesis in us.

We will end here our exegesis of a subject that is neither distinct nor definable. Even though, undoubtedly, more articles will be published on the theme of "animal-type melanoma/epithelioid blue nevus/pigmented epithelioid melanocytoma," we trust that we have demonstrated convincingly that those "concepts" are mere confabulations and that any publication in the future that employs those terms does not deserve a reading. It was that conviction that prompted us, from a point of view polemical, to use words denigrating ad rem of concepts we deem to be worse than woolly. In no way do we mean, however, to denigrate ad hominem the authors of the ideas.

We will close our reflections on this subject with the words of W. D. Castle (Harvard Bull. 1955), he expressing in a single sentence all that need be said about "animal-type melanoma" and the advocates of it: "An expert is a person who tells you simple things in a confused way, in such a fashion as to make you think the confusion is your own fault."