This paper describes the histogenesis of 3 forms of human malignant melanoma: superficial spreading melanoma, nodular melanoma, and lentigo maligna melanoma. A comparative analysis by computer of the biologic behavior and clinical characteristics of the different neoplasms has been done. An additional 60 tumors have been studied by serial block sectioning. Evidence is presented suggesting that superficial spreading melanoma and lentigo maligna melanoma (Hutchinson's melanotic freckle), though evolving at different rates, show a long period of superficial growth, followed by the relatively rapid appearance of nodules or deeper invasion within the primary lesion. This change in the nature of the primary lesion may be due to the appearance of one or more strains of cells of aggressive biologic potential. Thus the primary melanoma may exist for a relatively long period of time during which host selectional forces act to permit the growth of quite malignant strains of cells. It is these cells that seem to be capable of deeper growth. The subdivision of each of the forms of melanoma into 5 anatomic levels of invasion permits the accurate assignment of prognosis to each case. It is suggested that melanomas are tumors of the epidermal melanocytes and are not necessarily derived from melanocytic nevi. Each melanoma has a distinctive clinical appearance, even in its superficial and curable phases, and this appearance is the same whether or not the process arose in association with a melanocytic nevus.
Supported by grants from the National Cancer Institute CA-06221, the Massachusetts Division of the American Cancer Society, and the Damon Runyon Fund.