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January 1984

The Diagnosis of Malignant Melanoma In Situ

Author Affiliations

Department of Dermatology Stanford University School of Medicine 300 Pasteur Dr Stanford, CA 94305

Arch Dermatol. 1984;120(1):21. doi:10.1001/archderm.1984.01650370027005

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To the Editor.—  The letter by Jack C. Redman, MD, entitled "Call Level I (In Situ) Malignant Melanoma What It Is" (Archives 1983;119:452) encourages the expression of another viewpoint.Redman's argument for the use of the term level I malignant melanoma, in many cases now classified by pathologists as atypical melanocytic hyperplasia, implies that malignant behavior of a melanocytic lesion that is limited to the epidermis can be predicted from its histologic appearance. That this is true cannot be proved, since recognition of such a lesion always follows excision of the affected tissue. Thus, a diagnosis of malignant melanoma in such a situation is a guess on the part of a pathologist, especially if he is unable to recognize an invasive type of intraepidermal extension of the lesion. Moreover, there are inevitable differences of opinion as to how much atypia might justify the use of the term melanoma. The wide

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