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Dermatopathology: Practical & Conceptual July - September 2002
Flawed Concept: Staging of Melanoma: A Critique in Historical Perspective
Bradley Bakotic, D.O.
A. Bernard Ackerman, M.D.
Systems of Staging in Chronologic Sequence: L.V. Ackerman and Delgato (1947)
American Joint Committee on Cancer (1962–1965)
McNeer and Das Gupta (1964)
M.D. Anderson Cancer Center (1976)
American Joint Committee on Cancer (1977)
Union Internationale Contre Le Cancer (1978)
American Joint Committee on Cancer (1983)
American Joint Committee on Cancer and Union Internationale Contre le Cancer (1988, 1992, 1997)
American Joint Committee on Cancer (2000, 2001)
“Evolution” in Staging is Paralleled by Devolution in Critical Thought
During the last half of the 20th century until the present day, general pathologists have been obsessed by staging melanoma. That the method employed for achieving that desideratum, which had as its animating force a longing to determine prognosis for an individual patient with that malignant neoplasm, failed miserably can be inferred from the fact that successive efforts every few years by teams of supposed authorities, such as those of the American Joint Committee on Cancer (AJCC), resulted in a new system for staging that bore little resemblance to the one immediately before it or the one that was to come after it. In short, the various attempts to stage melanoma were nothing more than witchcraft and sorcery in which pathologists sought to be diviners, seers, and prophets about prognosis, rather than the diagnosticians that they were trained to be and should be. The job of a pathologist is to render an accurate diagnosis (which, in itself, has implications prognostically for a patient, e.g., "benign" or "malignant"), not to speculate about prognosis. To guess about how a patient with melanoma will fare, the system for staging being nothing other than pure conjecture, not only is unscientific, it is unethical.
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