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Correspondence |

Fast-Growing and Slow-Growing Melanomas

Giuseppe Argenziano, MD; Iris Zalaudek, MD; Gerardo Ferrara, MD
Arch Dermatol. 2007;143(6):799-816. doi:10.1001/archderm.143.6.802.
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We read with great interest the article by Liu et al1 and the accompanying editorial by Lipsker2 on rapidly growing melanomas. Both articles point out that different types of melanomas exist in relation to their biological propensity to grow and metastasize. Based on patient recall, Liu et al1 calculated the rate of growth of 404 invasive melanomas (median tumor thickness, 1.3 mm) and found that almost a third of them grew 0.5 mm per month or more. These rapidly growing melanomas are more likely thick tumors associated with a high mitotic rate and more frequently found in older men with fewer melanocytic nevi and freckles. Furthermore, they usually lack the clinical ABCD features of melanoma (A, asymmetry; B, border irregularity; C, color variegation; D, diameter >5 mm), being frequently symmetric and amelanotic nodules. The authors conclude that the lack of the most important risk factors for melanoma (ie, large number of nevi and freckles) and the lack of the typical melanoma features (ie, ABCD criteria) make it more difficult for the physician to identify this subtype of rapidly growing melanoma.

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Figure.

Clinical (A) and dermoscopic views at baseline (B) and follow-up consultation (C) of a 0.45-mm-thick melanoma located on the abdomen of a 57-year-old man. The lesion was excised 4½ years after the baseline consultation because of slight changes detected in side-by-side comparison of dermoscopic images. After such long-term follow-up, the lesion exhibits only a minor increase in size.

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