Why Is Darkness an Essential Feature for Melanoma Recognition?

Most conditions and diseases have one or more features that are essential for recognizing the most common presentations of the disease. Melanoma is a cancer of pigment-producing cells, and the term "melanoma" is derived from the Greek term for "dark tumor." Many, if not most, descriptions of melanomas include their being in general dark brown or black; however, the most utilized set of criteria for melanoma education, the ABCDE (asymmetry, border irregularity, color variation, diameter > 6mm, evolving) criteria, omits darkness as even one of the five emphasized features. A growing number of current approaches to melanoma recognition have addressed this need. In 2019, the Skin Cancer Foundation, for example, added that the "D" in the ABCDE mnemonic represents not just "Diameter" but also "Dark" (https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/ Accessed April 5, 2020). The Georgia approach, for which this author advocates, includes an increase in emphasis on a screening look, with dark, different, and changing as screening features, as well as a "D" for "Dark" change in the ABCDE criteria.1 Given the number of new strategies for melanoma education being developed, it is a particularly appropriate time to review the logic and rationale of why darkness is an essential feature for recognition of melanoma.

A unifying approach to the clinical diagnosis of melanoma including "D" for "Dark" in the ABCDE criteria.

Current clinical approaches to melanoma diagnosis have not been associated with a decrease in mortality from this cancer. The components of the new approach presented are, first, a screening examination to look for any lesion that stands out because of being dark, different, or changing; second, when a single lesion is recognized to be of concern for any reason, that lesion is then evaluated in more detail utilizing the ABCDE criteria, with the "D" signifying "Dark" and not "6 mm Diameter" in this mnemonic; and, third, additional discussion of the "ugly duckling" sign and of the recognition of nodular melanomas. Since the Georgia Society of Dermatology and Dermatologic Surgery was the first state or national society to endorse this approach, I refer to it as the Georgia approach.

Primary cutaneous adenoid cystic carcinoma of the scalp with p16 expression: a case report and review of the literature.

INTRODUCTION: Adenoid cystic carcinoma (ACC) is a rare carcinoma that typically arises in salivary glands but can also occur in other sites including skin. Primary salivary ACC is a locally aggressive tumor characterized by local recurrence and late metastasis. Primary cutaneous ACC is found predominately on the scalp and is more indolent than salivary ACC; and, despite a high incidence of local recurrence, metastases are exceedingly rare. METHODS: A 62-year-old white male presented with a 6-mm mobile, blue-tinted nodule on the left mid scalp unchanged for several years. RESULTS: The histopathological findings of an excisional biopsy were diagnostic for a primary cutaneous ACC. Immunohistochemistry demonstrated focal positivity for p16. CONCLUSIONS: Primary cutaneous ACC is a rare malignancy that should be considered in the differential diagnosis of adnexal neoplasms and, when occurring on the head and neck, must be distinguished from cutaneous involvement by salivary ACC. The majority of reported salivary ACC with p16 protein expression were not positive for high-risk human papilloma virus by in situ hybridization. Immunostaining for p16 has previously been reported in salivary gland ACC. This is the first report in the English literature of p16 immunoexpression in primary cutaneous ACC.