The current status of the melanoma problem.

Because of many recent diagnostic and therapeutic advances, malignant mel-anoma has been receiving new notoriety. Nevertheless, it is far from a new disease. Hippocrates (1) is credited with the first description of the lesion, which has always been regarded with some fear and superstition. There was little contribution of any significance until the seventeenth century, when Highmore, Bartholin, and Bonet at various times described the "fatal black tumor" (2). In 1806, Laennec and Du-puytren independently published treatises on melanosis (1). Thirty years later, Cars-well coined the term melanoma (1). Pemberton (3), in 1858, was the first to note the significance of the regional lymph nodes and suggested lymphadenectomy. In 1868, Langerhans (4) noted melanocytes in histologic specimens of skin as the "branched cells," but it was not until 1951 that the term melanocyte was adopted. Wide excision with regional node dissection was introduced by Handley (5) in 1907. This concept was expanded by Pringle (6) the following year to include depth with the primary excision. More recent advances are seen with the work of Creech (7), who introduced regional perfusion in 1958 by the use of an extracorporeal circuit, and the introduction of immunotherapy by Morton et al. (8) in 1970. These historical milestones are summarized in Table 1 and may also be found, along with a statistical review of the subject, in Knutson's monograph (9). Current concepts of melanoma fall naturally into four broad areas: (i) diagnosis, (ii) staging, (iii) surgery, and (iv) immunology. A symposium on melanoma was prepared for Surgical Grand Rounds at Yale University in January of 1975, based on such an outline. The first paper deals with the clinical appearance of melanoma and some important points in the differential diagnosis of these lesions. Since there are an average of 15 pigmented nevi per Caucasian, if 10,000 surgeons worked 8 hr/day excising one nevus every 15 min, then the current population would be free of nevi in 25 yr (Table 2). In order to avoid having to excise or biopsy every nevus, Dr. Nord-lund presents the important features of nevi that should make one suspicious of the diagnosis of melanoma. In so doing, he discusses the first classification system that differentiates melanomas by appearance: lentigo maligna (Hutchinson freckle), superficial spreading, and nodular. One of the most important advances in the study of melanoma has been the recognition of the importance of pathologic classification by depth, as …