Søndergaard K
Virchows Arch A Pathol Anat Histopathol. 1983;401(3):315-31. doi: 10.1007/BF00734848.
In 1916 patients with primary malignant melanoma of the skin (excluding palms, soles, and nailbeds) the primary lesions were reviewed microscopically and classified according to Clark's system into lentigo maligna melanoma (85), superficial spreading melanoma (1234), and nodular melanoma (513). Differentiation between the types was not possible in 84 melanomas (4%). By correlating type of melanoma with various clinical and histological features, it was found that the 3 types differed significantly from one another with regard to growth rate of tumor, antecedent nevus, dominant type of invasive tumor cell, and prognosis. The study thus supported the basic principle of the classification employed, that the 3 histological types represent distinct entities of cutaneous melanoma with different clinical, cellular, and behavioral characteristics. As originally described by Clark, the growth rate was greatest for nodular melanoma, followed by superficial spreading melanoma, and least for lentigo maligna melanoma. It is recommended that this classification be employed in the histological typing of cutaneous melanoma as 1) it is readily applied to the vast majority of melanomas, and 2) it seems to delineate separate clinico-pathologic entities of cutaneous melanoma, which might be correlated with aetiological differences.
对1916例原发性皮肤恶性黑色素瘤患者（不包括手掌、足底和甲床）的原发性病灶进行了显微镜检查，并根据克拉克系统将其分为恶性雀斑样黑色素瘤（85例）、浅表扩散性黑色素瘤（1234例）和结节性黑色素瘤（513例）。84例黑色素瘤（4%）无法区分类型。通过将黑色素瘤类型与各种临床和组织学特征进行关联，发现这三种类型在肿瘤生长速度、先前存在的痣、侵袭性肿瘤细胞的主要类型以及预后方面存在显著差异。该研究因此支持所采用分类的基本原则，即这三种组织学类型代表具有不同临床、细胞和行为特征的皮肤黑色素瘤的不同实体。如克拉克最初所描述的，结节性黑色素瘤的生长速度最快，其次是浅表扩散性黑色素瘤，恶性雀斑样黑色素瘤的生长速度最慢。建议在皮肤黑色素瘤的组织学分型中采用这种分类，因为1）它很容易应用于绝大多数黑色素瘤，2）它似乎可以区分皮肤黑色素瘤的不同临床病理实体，这可能与病因学差异相关。
