A RETROSPECTIVE HISTOLOGICAL STUDY OF 669 CASES OF PRIMARY CUTANEOUS MALIGNANT MELANOMA IN CLINICAL STAGE I

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Abstract
A selected series of primary malignant melanoma of the skin, clinical stage I, was originally classified according to Clark''s system. The consistency of this classification was tested by 2 Brisbane pathologists who indicated that some cases of superficial spreading malignant melanoma were misinterpreted as lentigo maligna melanoma. The original group of 86 lentigo maligna melanomas were reclassified. This resulted in a total series of 37 (5.5%) lentigo maligna melanomas, 301 (45%) superficial spreading malignant melanomas, 194 (29%) nodular malignant melanomas (unchanged) and 137 (20.5%) unclassifiable malignant melanomas. The diagnosis of lentigo maligna melanoma was not made unless the epidermis was atrophic and dermal solar elastosis was present. The new group of lentigo maligna melanomas is dominated by cases on the head among patients over 50 yr of age (especially women). This is in better agreement with other studies than previous findings. The relationship with tumor cell type, pigmentation, mitotic count, atypia, transsectional profile, level of invasion, ulceration, vascular invasion, lymphocyte infiltration and prognosis shown by the new groups of lentigo maligna melanoma and superficial spreading malignant melanoma indicates that the cases in which the diagnosis was changed are relatively benign. Previous conclusions are still valid. The lentigo maligna melanoma is still the most benign type and the nodular malignant melanoma still the most malignant type of melanoma. The superficial spreading malignant melanoma still represents an intermediate tumor type, although it has deviated in the benign direction.

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