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May 20, 1992

Melanomas That Defy Clinical Recognition

Author Affiliations

Walter Reed Army Medical Center Washington, DC

JAMA. 1992;267(19):2605. doi:10.1001/jama.1992.03480190047025

To the Editor.  —We read with interest the article by Drs Anderson and Silvers1 on melanoma that defied clinical recognition before final pathologic examination of the excised lesions. They described 13 cases, most of which were amelanotic, located on the extremities, neck, scalp, back, and ears, and were initially diagnosed as benign lesions or basal cell carcinomas. These were genuine false-negative melanomas in which melanoma was not even remotely considered as a diagnostic possibility before biopsy. The benign-appearing lesions reported by Anderson and Silvers had a hyperkeratotic or verrucous appearance and were diagnosed as seborrheic keratosis or verruca vulgaris.To add to the experience of Anderson and Silvers, we have recently treated an 85-year-old white man who presented with a verrucous-appearing scrotal lesion that on excisional pathology revealed primary scrotal melanoma, although melanoma was not considered before biopsy. The man had a 1-year history of a gradually enlarging hyperkeratotic,