But... Was There Ever a Clark Classification of Melanomas?

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"apellidos" => "Sánchez Yus" "email" => array:1 [ 0 => "evasyus@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Herrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "R.S." "apellidos" => "Simón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Requena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departamento de Medicina II (Dermatología), Facultad de Medicina, Universidad Complutense, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital del Henares, Coslada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Virgen de la Salud, Toledo, Spain" "etiqueta" => "c" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento de Dermatología, Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pero... ¿hubo alguna vez una clasificación de Clark de los melanomas?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-02-06" "fechaAceptado" => "2009-07-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec84658" "palabras" => array:3 [ 0 => "Clark classification of melanoma" 1 => "Acral lentiginous melanoma" 2 => "Breslow" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84659" "palabras" => array:3 [ 0 => "Clasificación de Clark de los melanomas" 1 => "Melanoma lentiginoso acro" 2 => "Breslow" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "For the past 40 years, the Clark classification of cutaneous melanoma has been accepted and used by the vast majority of dermatologists and pathologists throughout the world. However, after careful rereading of the most relevant articles by Clark and his collaborators, we can affirm that the classification was only ever of passing validity. After distinguishing between nodular melanoma, superficial spreading melanoma (SSM), and lentigo maligna melanoma (LMM) in 1968, the inclusion of acral-lentiginous melanoma (ALM) in 1979 as a new subtype was the first serious setback for the classification; in contrast to ALM, late-onset lentiginous melanomas, such as LMM, were situated on areas of skin with less exposure to sunlight.Later, the same authors found that, contrary to their initial belief, the prognosis of LMM was the same as that of other subtypes with the same Breslow thickness. Finally, a number of observations by the same authors made ever clearer the increasing difficulty for distinguishing microscopically between LMM, SSM, and ALM, except by taking their localization into consideration. This means that, today, the possible morphological differences between one case of cutaneous melanoma and another are of no proven prognostic implication. In addition, the morphological differences that can be found are much more closely related to the different localization than to the tumor itself." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Desde hace 40 años, la inmensa mayoría de los dermatólogos y los patólogos de todo el mundo ha aceptado y ha empleado la clasificación de Clark de los melanomas cutáneos. Sin embargo, tras una cuidadosa relectura de los artículos fundamentales de Clark y sus colaboradores, hemos podido comprobar que tal clasificación ha sido en realidad muy efímera.Tras distinguir en 1968 entre melanoma nodular, melanoma de extensión superficial (MES) y melanoma del lentigo maligno (MLM), la inclusión en 1979 del melanoma lentiginoso acro (MLA) como un nuevo subtipo de melanoma fue la primera avería seria de la clasificación, ya que un melanoma lentiginoso y de aparición tardía (como el MLM) se localizaba, a diferencia de éste, en las zonas menos fotoexpuestas de la piel. Posteriormente, los mismos autores comprobaron que, contrariamente a su idea inicial, el pronóstico del MLM era el mismo que el de los demás subtipos a igualdad de espesor, según Breslow. Finalmente, diversas observaciones de los mismos autores fueron poniendo de manifiesto su creciente dificultad para distinguir al microscopio entre MLM, MES y MLA, salvo que tuviesen en cuenta la localización.Es decir, que hoy por hoy las posibles diferencias morfológicas entre uno y otro caso de melanoma cutáneo no conllevan demostradas diferencias pronósticas, y las diferencias morfológicas que puedan encontrarse se deben más a la diferente localización que a la propia neoplasia." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The classification of malignant melanoma and its histologic reporting" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V.J. McGovern" 1 => "M.C. Mihm" 2 => "C. 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