Melanoma Diagnosis in the Mihm Era-And Beyond.

IF 1.6 4区 医学 Q3 DERMATOLOGY
David E Elder
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Abstract

During the illustrious career of Martin C. Mihm Jr., MD, the diagnosis of melanoma underwent significant changes, to which he made many contributions. In early descriptions, melanomas were fungating tumor masses that were obviously malignant, and highly lethal. In seminal work by Dr. Mihm and his mentor, Wallace H. Clark, Jr., MD, the early phases of development of these neoplasms were recognized and distinguished from the more advanced disease. It was generally believed that the early stage of melanoma, termed radial growth phase (RGP) and characterized by absence of vertical growth phase (VGP) and by favorable microstaging attributes could be recognized, excised, and cured, thus preventing the development of advanced disease. However, strenuous efforts in this direction over several decades have resulted in little or no change in mortality, leading to the recognition that many of these neoplasms, at least, may not be true biological malignancies, and to the conclusion that overdiagnosis commonly occurs in this disease, which is defined as representing diagnosis as melanoma of a neoplasm that would not have had the capacity to cause death or symptoms in the lifetime of the host. Although there may be other subsets of neoplasms in this category, an important category of overdiagnosis in melanomas is concentrated in T1a melanomas that lack VGP. If these neoplasms can be recognized with sensitive and specific criteria, which may already be available, changes in terminology may be appropriate, recognizing that some of them may have low malignant potential, whereas others may have no capacity at all for metastasis and may not warrant the use of the term "melanoma."

米姆时代及其后的黑色素瘤诊断。
在小马丁-C-米姆(Martin C. Mihm Jr.)医学博士的辉煌职业生涯中,黑色素瘤的诊断发生了重大变化,他为此做出了许多贡献。在早期的描述中,黑色素瘤是一种明显恶性、致死率极高的发泡性肿瘤肿块。在米姆博士和他的导师小华莱士-克拉克医学博士的开创性工作中,人们认识到了这些肿瘤的早期发展阶段,并将其与晚期疾病区分开来。人们普遍认为,黑色素瘤的早期阶段被称为径向生长期(RGP),其特点是没有垂直生长期(VGP),并且具有良好的微观分期属性,可以被识别、切除和治愈,从而防止晚期疾病的发展。然而,几十年来朝着这个方向努力的结果是死亡率几乎没有任何变化,因此人们认识到,至少其中许多肿瘤可能不是真正的生物恶性肿瘤,并得出结论认为,这种疾病通常会出现过度诊断,过度诊断的定义是将宿主一生中都不会导致死亡或症状的肿瘤诊断为黑色素瘤。虽然这一类肿瘤中可能还有其他子集,但黑色素瘤中一个重要的过度诊断类别集中在缺乏 VGP 的 T1a 黑色素瘤中。如果这些肿瘤可以用敏感而特异的标准来识别(这些标准可能已经存在),那么术语上的改变可能是合适的,因为我们认识到其中一些肿瘤可能恶性程度较低,而另一些肿瘤可能根本没有转移能力,因此可能不值得使用 "黑色素瘤 "这一术语。
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来源期刊
CiteScore
3.20
自引率
5.90%
发文量
174
审稿时长
3-8 weeks
期刊介绍: Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.
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