The histogenesis and biologic behavior of primary human malignant melanomas of the skin.

TLDR

This study examines the histogenesis of three major human malignant melanoma types—superficial spreading, nodular, and lentigo maligna—highlighting their distinct growth patterns and the potential emergence of aggressive cell strains over time. The authors performed a computer‑based comparative analysis of 60 melanoma tumors, employing serial block‑sectioning and subdividing each type into five anatomic invasion levels to enable precise prognostic assignment. They found that superficial spreading and lentigo maligna melanomas undergo a prolonged superficial growth phase before rapidly developing nodules or deeper invasion, and that each melanoma exhibits a unique clinical appearance regardless of nevus association.

Abstract

Summary This paper describes the histogenesis of 3 forms of human malignant melanoma: superficial spreading melanoma, nodular melanoma, and lentigo maligna melanoma. A comparative analysis by computer of the biologic behavior and clinical characteristics of the different neoplasms has been done. An additional 60 tumors have been studied by serial block sectioning. Evidence is presented suggesting that superficial spreading melanoma and lentigo maligna melanoma (Hutchinson9s melanotic freckle), though evolving at different rates, show a long period of superficial growth, followed by the relatively rapid appearance of nodules or deeper invasion within the primary lesion. This change in the nature of the primary lesion may be due to the appearance of one or more strains of cells of aggressive biologic potential. Thus the primary melanoma may exist for a relatively long period of time during which host selectional forces act to permit the growth of quite malignant strains of cells. It is these cells that seem to be capable of deeper growth. The subdivision of each of the forms of melanoma into 5 anatomic levels of invasion permits the accurate assignment of prognosis to each case. It is suggested that melanomas are tumors of the epidermal melanocytes and are not necessarily derived from melanocytic nevi. Each melanoma has a distinctive clinical appearance, even in its superficial and curable phases, and this appearance is the same whether or not the process arose in association with a melanocytic nevus.