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    2 views11 pages

    DSKDJFLD

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    of 11
    128 © [CANCER RESEARCH 29, 705726, March 1969) The Histogenesis and Biologic Behavior of Primary Human Malignant Melanomas of the Skin’ Wallace H. Clark, Jr.,? Lynn From, Evelina A. Bernardino, and Martin C. Mihm Departments of Pathology and Dermatology, Massachusetts General Hocptal end Harvard Medical School, Boston, Massachusetts 02114 SUMMARY ‘This paper describes the histogenesis of 3 forms of human aaalignant melanoma: superficial spreading melanoma, nodular melanoma, and lentigo maligna melanoma. A comparative analysis by computer of the biologic behavior and clinical Al Gharacteristcs of the different neoplanis has been dom ‘Maional 60 sumors have been studied by serial block set lng Evidence ie presented suggesting that superficial spreading trelanoma and lentigo maligne melanoma {Hutchinson's mele tots freckle), thoagh evclng a differen rates, show 2 long period of supericial growth, followed by the relatively cap Eppeaance of nodules or deeper invasion within the pinay iedon. "This change in the nator of the primary lesion may Be die to the appearance of one or more stains of clls of aggres are biologie potenti, Thus the primary melanoma may scat fora relate long period of tne dering which hor selec sional forces set to pent the gowth ef qulte malignant tvs of cells, Iti these cells teat seem t6 be capac of deeper growth "The subdivision of each of the form of mele: toma into § anatomte levels of Invasion permits the accarte signment of prognosis to each case It mggested that mela oman ae furore of the epidermal melanocyecr snd are not cestariy derived from melanocyti new, Bach maGROHS Tat s-aUemTeTie CIncal appearance even Ties superficial ead catable phases, and this sppeacance leche same whether or not the proce arose in asociaton with a melanocyte neva INTRODUCTION ‘This paper describes 3 different malignant tumors affecting the human epidermal melanocytic system. ‘These neoplastic processes are described under the terms superficial spreading melanoma, nodular melanoma, and lentigo maligna melanoma {Hutchinson's melanotic freckle or circumscribed precancerous ‘elanosis of Dubreuilh). Each of these tumors has a recogniz~ able appearance in the patient, distinctive microscopic charac teristics, and to a certain extent unique fine structural fea- tures, The history of the evolution of each of the primary supported by grants from the National Cancer Institute CA-06221, the Massachusets Division of the American Cancer Society, and the Damon Rsnyon Fund Present address: Temple University School of Medicine, Dept. of Pathology, 3420 N. Broad St, Philadelphia, Pennryrania 19140, Received July 8, 1968; accepted November 4, 1968, MARCH 1969 coplms i different, and each has 2 predictable biologic be. havior. Furthermore, withia each kind of tumor, behave may be accurately predicted by the depth of invasion of the neo. plastic cells, Finally, various Focation and age siso serve in distinguish 7ielzmomss——— We shall lio discuss the elatonship of che junetion neva malignant melanoma. Tes ov opinion that the junction never fas formal bist 1g the various a che tamors arising in these lesions are of no statistical importance ia the overall problem of melanoma, We regard the majority of melanomas as malig- ant neoplasms of epidermal melanocytes. This. pigmen synthesizing system has a specific distibution throughout the normal epidermis (27, 39, 40), andthe cells ofthe system may be found in a variety of cutaneous lesions inchuding the intta- epidermal component of various nevi. Regardless of whore melanocytes are located, in normal skin, in freckles, in pig rented nevi or in other benign lesions, the etiologic factors, as yet largely unknown, that cause melanoma can act upon these melanocytes, The concept of the junction neris as 4 premalignant lesion seems to have abscured the fact that mos. malignant melanomas pass through a long phase of superficial tgomth during which the process differs in appearance fro junctional nevi and is easly recognized on clinial exami ation. MATERIALS AND METHODS ‘This report is based upon the study of 3 series of malignant melanomas observed at the Massachusetts General Hospital. ‘The first series consisted of 96 cases observed prior to Jan. 1, 1958. These cases were selected solely on the basis of the availability of technically satisfactory histologic material of the primary neoplasm and on adequate followsp information ‘The histogenetic concepts underlying much of the present re port were formulated through the investigation of the first Series of 96 melanomas and have been previously reported in, detail (5), These 96 cases have been incorporated with the second series of 113 cases observed between January 1958, and October 1965, and subjected co statistical analysis by computer. The third series of melanomas consists of 60 cases observed from October 1965 through May 1968, which have been studied in detail, clinically and morphologically, but not incorporated into the statistical study because of short follow. 705 ee Wallace H. Clark, Jr, Lynn From, Evelina A, Bernardino, and Martin C, Mikn ‘me. Vietually all of those patients have been seen through

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