Is it Melanoma?

Growth and Development of Primary Skin Melanomas: A Short Atlas

Author: DuPont Guerry, MD Affiliations: Director, Melanoma Program University of Pennsylvania Cancer Center Chair, Melanoma International Foundation Advisory Board

Copyright © 1996, The Trustees of the University of Pennsylvania

Melanomas develop initially as a flat phase without competence for metastasis called the radial growth phase. They then may evolve focally an elevated part, the vertical growth phase, with metastatic competence.

Generally, the radial growth phase is described by the A,B,C,D's of melanoma:

Radial growth phase melanomas, although invasive, have a cure rate that approaches 100% with surgery alone. Figures 1 and 2 are radial growth phase melanomas of the superficial spreading type, the most common form in white populations. This type is associated with excessive, intermittent sun exposure (especially in childhood and youth).

Figures 5 and 6 are radial growth phase, acral-lentiginous melanomas. These occur in all races at a very low rate on palms, soles of the feet, and under the nails.

Figures 7, 8, and 9 are melanomas that have evolved focal areas of vertical phase. Overall, patients with vertical growth phase melanomas have a cure rate of 70%. Individual prognosis is dependent on such factors as tumor thickness, lymphocytic infiltration into the vertical growth phase, proportion of tumor cells in mitosis, ulceration, tumor location, and the patient's sex.

Guerry, D., Synnestvedt, M, Elder, DE, Schultz D: Lessons from Tumor Progression: The Invasive Radial Growth Phase of Melanoma is Common, Incapable of Metastasis and Indolent. J. Invest. Dermatol. 100: 3425-3455, 1993.

Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Shultz D, Synnestvedt M, Halpern A: Model Predicting Survival in Stage I Melanoma Based on Tumor Progression. J. Natl Cancer Inst. 24: 1893-1904, 1989.



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UPDATE: March  6, 2011