Types of melanoma?

T here is, perhaps, no other class of neoplasm in the discipline of cutaneous medicine that evokes fear in patients as deeply as does melanoma. This sarcoma, seemingly unpredictable as it is in its clinical presentation and its histologic mimicry of melanocytic nevi and other lineages of neoplasms, is indeed worthy of our respectebut not our fear. Fear is overcome by knowledge, and methods of diagnosis and management are its consequence. The last 60 years has been a period of focused research by dermatologists and dermatopathologists toward the desideratum of understanding which criteria, either alone or in combination, aid in establishing the diagnosis of melanoma. There has been a small, but intellectually potent, group of thinkers and writers who, during this period, have attempted to discover the criteria that dermatologists and dermatopathologists use to diagnose and report melanomas daily throughout the world. The most notable among these are Spitz, Allen, Helwig, Reed, Clark, Mihm, Ackerman, Elder, Breslow, Barnhill, and LeBoit. Yet, these same authors, the developers of the language of melanoma, disagree often with each other about the meanings of the words applied to stand for different patterns of those dreaded neoplasms. One person’s ‘‘superficial spreading melanoma’’ is another person’s ‘‘lentiginous melanoma.’’ ‘‘Nodular melanomas’’ for some are simply ‘‘nodules of melanoma’’ for others. One person’s ‘‘vertical growth phase’’ is another person’s refusal to accept such language on the grounds that no one knows