The pathology of malignant melanoma.

It is clear that much of what has been taught over the years concerning the pathology of melanoma may have little validity. Melanoma is viewed simply as a malignant neoplasm comprised initially of a proliferation of atypical melanocytes within the surface epithelium (epidermis). It has many features in common, regardless of anatomic site. It spreads within the epidermis first for months, possibly years or even for decades. At this stage (melanoma in situ) it is wholly curable if completely surgically excised. What determines how long a given melanoma remains in situ is not clear. It is probably a combination of factors, including host response to the neoplasm; physical barriers to growth and metastasis (perhaps solar damage); chemical or humoral growth factors or inhibitors (perhaps genetically determined); and other as yet undiscovered factors. Once a given neoplasm penetrates into the subjacent dermis, there are whole ranges of ill-defined events that act on its ability to continue to grow and develop the competence for metastasis (growth factors and inhibitors, neoangiogenesis factors and inhibitors, host immune responses, and so forth). Let us throw out all of our prejudices that may have developed or nurtured over the years. There is much to learn about the pathobiology of melanoma. Clinicians should keep their minds open to new concepts and try to separate what makes sense from that which does not.

Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria.

CONTEXT: The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (< or =6 mm) melanomas. EVIDENCE ACQUISITION: Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information. EVIDENCE SYNTHESIS: Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color. CONCLUSIONS: The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include "evolving"). No change to the existing diameter criterion is required at this time.

Dysplastic nevi.

Dysplastic nevi have been a subject of much debate since their original description in 1978. Although some question the biological potential of dysplastic nevi themselves, several studies have shown that their presence confers substantial risk for melanoma. In addition to predisposing patients to melanoma, dysplastic nevi have been shown to harbor genetic mutations, indicating their position on a continuum between banal nevi and melanomas. Dysplastic nevi are also clinically relevant as mimickers of melanoma, and can be challenging diagnostically. This article reviews the history, epidemiology, biology and genetics, clinical features, histopathologic features, and management guidelines for patients with these lesions.

The "dysplastic" nevus.

Dysplastic nevi have become an increasing focus clinically, with evidence that they are associated with a higher risk of developing melanoma. However, there still is contention regarding the significance of dysplastic nevi. This contribution provides an overview of the history, epidemiology, genetics, clinical and histologic features, and procedures for clinical management of dysplastic nevi. Since dysplastic nevi were described originally in 1978, a great deal of research has examined the epidemiology of these lesions and the genetic factors related to the development of dysplastic nevi. However, there is disagreement regarding the clinical management of dysplastic nevi and the histologic definition of dysplastic nevi. Current recommendations include preventative measures, such as sun protection and careful surveillance and biopsies of suspicious lesions as needed. The advent of new technologies, such as computer-vision systems, have the potential to significantly change treatment of dysplastic nevi in the future.

Utility of lesion diameter in the clinical diagnosis of cutaneous melanoma.

OBJECTIVE: To determine the utility of the current diameter criterion of larger than 6 mm of the ABCDE acronym for the early diagnosis of cutaneous melanoma. DESIGN: Cohort study. SETTING: Dermatology hospital-based clinics and community practice offices. Patients A total of 1323 patients undergoing skin biopsies of 1657 pigmented lesions suggestive of melanoma. MAIN OUTCOME MEASURE: The maximum lesion dimension (diameter) of each skin lesion was calculated before biopsy using a novel computerized skin imaging system. RESULTS: Of 1657 biopsied lesions, 853 (51.5%) were 6 mm or smaller in diameter. Invasive melanomas were diagnosed in 13 of 853 lesions (1.5%) that were 6 mm or smaller in diameter and in 41 of 804 lesions (5.1%) that were larger than 6 mm in diameter. In situ melanomas were diagnosed in 22 of 853 lesions (2.6%) that were 6 mm or smaller in diameter and in 62 of 804 lesions (7.7%) that were larger than 6 mm in diameter. Conclusion The diameter guideline of larger than 6 mm provides a useful parameter for physicians and should continue to be used in combination with the A, B, C, and E criteria previously established in the selection of atypical lesions for skin biopsy.

The diagnostic performance of expert dermoscopists vs a computer-vision system on small-diameter melanomas.

OBJECTIVE: To evaluate the performance of dermoscopists in diagnosing small pigmented skin lesions (diameter

Análise da tabela de vida para as taxas de sobrevida no melanoma maligno / Life-table analysis of survival rates in malignant melanoma

O progrma de computador do "Statistical Package for he Social Science" (SPSS) foi usado para determinar a taxa cumulativa de sobrevida abrangendo cinco anos, para paciente com melanoma maligno cutâneo, estágio I. A análise atuarial realizada na mesma data base de 1982 e novamente em 1987 apresentou uma considerável consistência em pre-dizer a taxa de sobrevida de cinco anos para este tumor

Cáncer de piel / Cancer of the skin

Profusamente ilustrado con fotografías, este texto es una exposición completa y actual, sobre neoplasias de la piel. Obra exelente. Su índice es: biología de la invasión y metástasis cancerosas cutáneas, epidemiología, posibles precursores de procesos malignos apidérmicos, carcinoma de células basales,escamosas y carcinoma verrugoso, oncogénesis viral en malignidades cutáneas, papulosis bowenoide, epidermodisplasia verruciforme, detección temprana de melanomas malignos: papel del exámen médico y el autoexámen de la piel, nevos displásicos, lesiones precursoras: nevos melanocíticos congénitos, melanoma maligno: correlaciones clinicopatológicas y tratamiento, factores pronóstico que influyen en la supervivencia de personas con melanoma maligno cutáneo, carcinomas de los anexos de la piel, enfermedad de Paget mamaria y extramamaria, lesiones seudosarcomatosas (neoplásicas y no neoplásicas) de la piel y tejidos superficiales, carcinoma de células de Merkel, neoplasias vasculares de la piel y asociadas con el SIDA, linfomas de células T cutáneos, enfermedades genéticas que predisponen a procesos malignos, cánceres metastáticos en la piel, manifestaciones dermatológicas de procesos malignos internos, nevo de grandes células fusiformes o epitelioides(nevo de Spitz), queratoacantoma, seudolinfomas cutáneos, técnicas de biopsia y principios quirúrgicos generales en el tratamiento del cáncer de piel, curetaje y electrodesecación terapéuticos, criocirugía, quimioterapia, cirugía con láser, cirugía plástica reconstructiva, radioterapia, inmunoterapia en el tratamiento de melanomas malignos, comprensión y tratamiento psicológico del paciente, el papel del oftalmólogo, problemas medicolegales en el manejo con pacientes con cáncer cutáneo

Cáncer de piel / Cancer of the skin

Profusamente ilustrado con fotografías, este texto es una exposición completa y actual, sobre neoplasias de la piel. Obra exelente. Su índice es: biología de la invasión y metástasis cancerosas cutáneas, epidemiología, posibles precursores de procesos malignos apidérmicos, carcinoma de células basales,escamosas y carcinoma verrugoso, oncogénesis viral en malignidades cutáneas, papulosis bowenoide, epidermodisplasia verruciforme, detección temprana de melanomas malignos: papel del exámen médico y el autoexámen de la piel, nevos displásicos, lesiones precursoras: nevos melanocíticos congénitos, melanoma maligno: correlaciones clinicopatológicas y tratamiento, factores pronóstico que influyen en la supervivencia de personas con melanoma maligno cutáneo, carcinomas de los anexos de la piel, enfermedad de Paget mamaria y extramamaria, lesiones seudosarcomatosas (neoplásicas y no neoplásicas) de la piel y tejidos superficiales, carcinoma de células de Merkel, neoplasias vasculares de la piel y asociadas con el SIDA, linfomas de células T cutáneos, enfermedades genéticas que predisponen a procesos malignos, cánceres metastáticos en la piel, manifestaciones dermatológicas de procesos malignos internos, nevo de grandes células fusiformes o epitelioides(nevo de Spitz), queratoacantoma, seudolinfomas cutáneos, técnicas de biopsia y principios quirúrgicos generales en el tratamiento del cáncer de piel, curetaje y electrodesecación terapéuticos, criocirugía, quimioterapia, cirugía con láser, cirugía plástica reconstructiva, radioterapia, inmunoterapia en el tratamiento de melanomas malignos, comprensión y tratamiento psicológico del paciente, el papel del oftalmólogo, problemas medicolegales en el manejo con pacientes con cáncer cutáneo