Methodological Search for Historical Evidence of Melanomas Spreading to the Skin

Melanoma is defined as a pigmented cancer, the word itself dating to 1838. A decade later, the Pathological Society of London came into existence. Therefore, I have searched methodologically my collection of these historical treasures. As the obtained panorama ranged from the isolated to the variegated, it is deemed worthy of publication.


Introduction
The Merriam-Webster's Collegiate Dictionary defined melanoma as a characteristically pigmented growth and dated its use in the English Language to 1838 [1]. Interestingly, a decade later, the Pathological Society of London came into existence [2]. Having accumulated many photocopies of historical materials of inestimable value, I propose to search them methodologically in order to extract educative information. This has now been presented together with the illustrative diagrams special reference being made to melanomas spreading to the skin.

Historical Texts
To some extent, scanty information was found in a few of the papers. Thus, there may be limited spread to the "right flank" [3] or to the "opposite thigh". With regard to another organ, "There are a few small tumours in the skin near the breasts" [4].
Naturally, some cases were depicted with some doubt as to whether skin proper or subcutaneous tissue. Payne [5] painted the picture as "Several subcutaneous tumours were seen in different parts of the body-three or four small ones in the abdominal wall, and one as large as a chestnut over the right deltoid. " The joint authors, Calvert and Pigg [6], pointed to the existence of new growths found in skin, subcutaneous tissue and muscles. On his part, Ogle [7] observes them "in many places, under the superficial integuments of the chest and abdomen, appearing in the latter places, as slight elevations of the skin. " Target [8] was succinct thus: "There were numerous melanotic nodules scattered over the surface of the body and the limbs. "

Likewise, Mackenzie [9] was expansive as follows
In the deeper layers of the skin, or more probably subcutaneous, there are here and there firm, elevated, circumscribed nodules of a yellowish-white colour as they appear through the skin, but darkbrown on section, and varying from the size of a pin's head to that of a large pea, freely moveable, and to the touch apparently lying subjacent to the surface. They are most numerous in the skin of the chest-wall and abdomen, while there are apparently none in the scalp, skin of the face, hands, or right leg, but one about the size of a large pea over the subcutaneous surface of the left tibia, freely moveable, and not at all adherent to the bone.
Moreover, there were patients in whom the lesions were scattered. Battle [10] used the word "universal. " Bryant [11] took the trouble to admit that his presentation was based on the report of Dr. Wills, who had found that "A number of nodules of all sizes were on the body, consisting of soft cancer containing pigment, some being absolutely black. " Beadles [12] described "a man who died from malignant disease, in whom multiple growths were found scattered externally over the skin. " See illustrative diagrams 1 and 2. Moreover, the localities were detailed as follows: Head: Situated on the left of the scalp in the upper temporal region a little behind the ear was a large fungating mushroom-shaped mass about two inches in diameter, irregular, ulcerated, and bleeding on the surface, connected to the scalp by a narrow pedicle. Immediately posterior to this was a tumour the size of a large marble, and another of similar size about three inches in front, neither of which was ulcerated. There was also in the middle line above the vertex of the skull a slightly raised rounded boss, which appeared to be a commencing growth.
Chest, front: Five small nodules were situated in the skin above the right breast, and a rather larger one above and to the outer side of the left breast. Two minute nodules existed towards the right lower costal margin, and two close together near the left margin. There was also a nodule on the left side of the neck.
Abdomen: Two minute nodules were visible in the skin on the right of the abdomen, and a larger mass the size of a hen's egg towards the right lumbar region. In the right groin was a large mass the size of a cricket ball, situated for the most part above but extending over Poupart's ligament. There was a smaller mass below and internal to this, and a small nodule also above the pubes. A mass the size of a pullet's egg existed below the left Poupart's ligament, and external to this was an old scar.
Legs: On the right thigh to the outer side were three nodules, and behind the upper part of the left thigh was another.
Back: Posteriorly there was a nodule over the vertebral border of the right scapula, a mushroom-shaped fungating growth immediately above the right iliac crest with a small nodule above it. A small scar was seen just below the inferior angle of the left scapula. This was apparently the seat of the primary wart.
Right arm: There were four nodules; two in front of the middle, one above and external, and one just above the internal condyle.
Left arm: One nodule in front and another above the external condyle of the humorous.

Discussion
Not long ago, Ackerknecht [13] acknowledged the need to know the historical origins of cancer. As he put it, "The first task faced by medicine was to discover clinically and macroscopically the different forms of cancer and to unite them in some common notion; more recently some knowledge as to its microscopic morphology [14], its physiology and causative factors has been acquired and some new therapeutic agents have been discovered. " In this context, it is well to learn that, by 1872, an anonymous writer [15] had reviewed broadly the "History of medicine. " By 1977, i.e., a century later, Burnet [16] hoped that modern writers would "read about the theories of brilliant men writing half a century ago. " Indeed, one should go further back as has been done in this methodological search of the Transactions of the Pathological Society of London, which began publications in 1846 [17].
It is amazing that, in those days, exact measurement was scarcely in vogue. Instead, the jumble of descriptions consisted of chestnut, large pea, large marble, pins head, cricket ball, and pullet's egg. In other words, there was reliance on the selected farming and other objects. Measurement was only reflected by the rare use of inches! Perhaps, this is indicative of the journey as it was being undertaken by the old masters. Obviously, this is in contrast with the progress being made in understanding the pathology of melanoma.