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Dermatopathologist reflects on the early history of melanoma


 

AT MELANOMA 2023

– Evidence of melanoma in the ancient past is rare, but according to James W. Patterson, MD, signs of melanoma with cutaneous lesions and diffuse bony metastases have been discovered in Peruvian Inca mummies.

“Radiocarbon dating indicated that these mummies were 2,400 years old,” Dr. Patterson, professor emeritus of pathology and dermatology at the University of Virginia, Charlottesville, said at the annual Cutaneous Malignancy Update.

Dr. James W. Patterson, professor emeritus of pathology and dermatology, University of Virginia, Charlottesville.

Dr. James W. Patterson

John Hunter, a famous British surgeon who lived from 1728 to 1793, had the first known reported encounter with melanoma in 1787. “He thought it was a form of cancerous fungus,” said Dr. Patterson, a former president of the American Board of Dermatology. “That tumor was preserved in the Hunterian Museum of the Royal College of Surgeons in London, and in 1968 it was reexamined and turned out to be melanoma.”

René Laënnec, the French physician who invented the stethoscope in 1816, is believed to be the first person to lecture on melanoma while a medical student in 1804. The lecture was published about a year later. He originated the term “melanose” (becoming black), a French word derived from the Greek language, to describe metastatic melanoma and reported metastasis to the lungs. During the early part of his career, Dr. Laënnec had studied dissection in the laboratory of the French anatomist and military surgeon Guillaume Dupuytren, best known for his description of Dupuytren’s contracture. Dr. Dupuytren took exception to Dr. Laënnec’s publication about melanoma and called foul.

“As sometimes happens these days, there was some rivalry between these two outstanding physicians of their time,” Dr. Patterson said at the meeting, hosted by Scripps MD Anderson Cancer Center. “Dupuytren was unhappy that Laënnec took credit for this because he claimed credit for originally describing melanoma. He claimed that Laënnec stole the idea from his lectures. I’m not sure that issue was ever resolved.”

In 1820, William Norris, a general practitioner from Stourbridge, England, published the first English language report of melanoma in the Edinburgh Medical and Surgical Journal. “The report was titled ‘A case of fungoid disease,’ so it appears that melanoma was often regarded as a fungal infection back then,” Dr. Patterson said. In the report, Dr. Norris described the tumor in a 59-year-old man as “nearly half the size of a hen’s egg, of a deep brown color, of a firm and fleshy feel, [and] ulcerated on its surface.” Dr. Norris authored a later work titled “Eight cases of melanosis, with pathological and therapeutical remarks on that disease.”

In 1840, a full 2 decades following the first published report from Dr. Norris, the British surgeon Samuel Cooper published a book titled “First Lines of Theory and Practice of Surgery,” in which he described patients with advanced stage melanoma as untreatable and postulated that the only chance for survival was early removal of the tumor.

Dr. Patterson reported having no relevant disclosures.

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