Lieblich L M
Am J Dermatopathol. 1982 Oct;4(5):435-41. doi: 10.1097/00000372-198210000-00010.
The Clark classification of malignant melanomas into four types is well known and widely used. This classification system has been recently challenged by Ackerman and subsequently defended by Elder, Jucovy, Tuthill, and Clark. Four areas of disagreement among these opposing authors are discussed. They include the reliability of the criteria used for distinguishing the four types of malignant melanomas, the possible site dependence of the four types of malignant melanomas, the differing definitions given to radial-growth phase, horizontal-growth phase, and vertical-growth phase; and whether a malignant melanoma can exist in a "pure" vertical-growth phase (nodular melanoma). An analogy to the classification of warts is made. The view of this paper is that all classification systems are arbitrary and thus are types of models. Like other models, they should be evaluated only in terms of their usefulness in explaining pathogenesis or predicting clinical outcome.
将恶性黑色素瘤分为四种类型的克拉克分类法广为人知且应用广泛。该分类系统最近受到阿克曼的质疑，随后埃尔德、朱科维、图希尔和克拉克为其进行了辩护。讨论了这些对立作者之间存在分歧的四个方面。它们包括用于区分四种类型恶性黑色素瘤的标准的可靠性、四种类型恶性黑色素瘤可能存在的部位依赖性、对放射状生长期、水平生长期和垂直生长期给出的不同定义；以及恶性黑色素瘤是否能以“纯粹”的垂直生长期（结节性黑色素瘤）存在。文中对疣的分类做了类比。本文的观点是，所有分类系统都是人为的，因此都是模型类型。与其他模型一样，对它们的评估只能依据其在解释发病机制或预测临床结果方面的有用性。
