Clinical recognition of the early or atypical malignant melanoma is often difficult. In recent analyses of the problem, Becker1 and McMullan and Hubener2 have shown the difficulty of such diagnosis, for the percentage accuracy of clinical diagnosis which they reported was in the range of 40%. These authors also listed many of the various types of benign lesions which may be mistaken for malignant melanomas. The problem of accurate clinical diagnosis is familiar to all physicians who manage and treat skin tumors, and the necessity for histopathological examination of all suspicious lesions is well recognized.
The commonly accepted danger signals suggesting a malignant melanoma include recent appearance of a new pigmented lesion, change in size or color of a pre-existing pigmented nevus, inflammatory change in a nevus, "migration" of pigment from a pigmented nevus to the surrounding skin, and, possibly most indicative, ulceration, hemorrhage, or serous exudation from
FREEMAN RG, KNOX JM. Epidermal Cysts Associated with Pigmented Nevi: A Combination Which May Simulate Malignant Melanoma. Arch Dermatol. 1962;85(5):590–594. doi:10.1001/archderm.1962.01590050020004
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