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December 4, 1987, Vol 258, No. 21 >
ARTICLE | December 4, 1987

Risk Factors for Cutaneous Melanoma: Title and subTitle BreakA Practical Method of Recognizing Predisposed Individuals FREE

Arthur R. Rhodes, MD, MPH; Martin A. Weinstock, MD, PhD; Thomas B. Fitzpatrick, MD, PhD; Martin C. Mihm, Jr, MD; Arthur J. Sober, MD
[+] Author Affiliations

Reprint requests to Department of Dermatology, Wellman 2, Massachusetts General Hospital, Boston, MA 02114 (Dr Rhodes).


JAMA. 1987;258(21):3146-3154. doi:10.1001/jama.1987.03400210088032
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Article
References

Cutaneous melanoma is rapidly becoming a potentially curable cancer if it is detected and properly treated in an early phase of development. Unlike other cancers, which are usually hidden from detection until they are relatively large or metastatic disease has occurred, cutaneous melanoma is readily detectable simply by examining the skin. Information is now available that will be useful in selecting individuals at greatest risk. The most important melanoma risk factors (in decreasing order of importance) for a given individual are as follows: a persistently changed or changing mole, adulthood, irregular varieties of pigmented lesions (including dysplastic moles and lentigo maligna), a congenital mole, Caucasian race, a previous cutaneous melanoma, a family history of cutaneous melanoma, immunosuppression, sun sensitivity, and excessive sun exposure. Selective screening and appropriate treatment of individuals who have these risk factors may reduce the morbidity and mortality of cutaneous melanoma.

(JAMA 1987 258:3146-3154)

REFERENCES

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Silverberg E, Lubera J:  Cancer statistics, 1987 . CA 1987;;37:2-19.
2 +
Horm JW, Asire AJ, Young JL Jr, et al: SEER Program: Cancer Incidence Mortality in the United States, 1973-1981 , US Dept of Health and Human Services publication (NIH) 85-1837. Bethesda, Md, National Cancer Institute, 1984;.
3 +
Vital Statistics of the United States, 1979 , US Dept of Health and Human Services publication (PHS) 84-1101. National Center for Health Statistics, 1984;, vol 2, pt A,  section 6 , p 8.
4 +
Roush GC, Schymura MJ, Holford TR:  Risk for cutaneous melanoma in recent Connecticut birth cohorts . Am J Public Health 1985;;75:679-682.
5 +
Balch CM, Soong S-J, Milton GW, et al:  Changing trends in cutaneous melanoma over a quarter century in Alabama, USA, and New South Wales, Australia . Cancer 1983;;52:1748-1753.
6 +
Silverberg E:  Cancer statistics . CA 1983;;33:3-26.
7 +
Balch CM, Urist MM, Maddox WA, et al:  Melanoma in the Southern United States: Experience at the University of Alabama in Birmingham , in Balch CM, Milton GW, Shaw HM, et al (eds): Cutaneous Melanoma: Clinical Management and Treatment Results Worldwide . Philadelphia, JB Lippincott, 1985;, pp 397-406.
8 +
Mihm MC Jr, Fitzpatrick TB, Lane-Brown MM, et al:  Early detection of primary cutaneous melanoma: A color atlas . N Engl J Med 1973;;289:989-996.
9 +
Sober AJ, Fitzpatrick TB, Mihm MC, et al:  Early recognition of cutaneous melanoma . JAMA 1979;;242:2795-2799.
10 +
Friedman RJ, Rigel DS, Kopf AW:  Early detection of malignant melanomas: The role of physician examination and self-examination of the skin . CA 1985;;35:130-151.
11 +
Elder DE, Greene MH, Bondi EE, et al:  Acquired melanocytic nevi and melanoma: The dysplastic nevus syndrome , in Ackerman AB (ed): Pathology of Malignant Melanoma . New York, Masson Publishers USA Inc, 1981;, pp 185-215.
12 +
Rhodes AR, Melski JW:  Small congenital nevocellular nevi and the risk of cutaneous melanoma . J Pediatr 1982;;100:219-224.
13 +
Doherty VR, MacKie RM:  Reasons for poor prognosis in British patients with cutaneous malignant melanoma . Br Med J 1986;;292:987-989.
14 +
Rhodes AR, Sober AJ, Mihm MC Jr, et al:  Possible risk factors for primary cutaneous malignant melanoma . Clin Res 1980;;28:252A.
15 +
Swerdlow AJ, English J, MacKie RM, et al:  Benign melanocytic nevi as a risk factor for malignant melanoma . Br Med J 1986;;292:1555-1559.
16 +
Rhodes AR:  Pigmented birthmarks and precursor melanocytic lesions of cutaneous melanoma identifiable in childhood . Pediatr Clin North Am 1983;;30:435-463.
17 +
Rhodes AR:  Melanocytic precursors of cutaneous melanoma: Estimated risks and guidelines for management . Med Clin North Am 1986;;70:3-37.
18 +
Rhodes AR:  Neoplasms: Benign neoplasias, hyperplasias, and dysplasias of melanocytes , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 3. New York, McGraw-Hill International Book Co, 1986;, pp 877-946.
19 +
Sober AJ, Day CL, Kopf AW, et al:  Detection of'thin' primary melanomas . CA 1983;;33:160-163.
20 +
Wick MM, Sober AJ, Fitzpatrick TB, et al:  Clinical characteristics of early cutaneous melanoma . Cancer 1980;;45:2684-2686.
21 +
Houghton A, Flannery J, Viola MV:  Malignant melanoma in Connecticut and Denmark . Int J Cancer 1980;;25:95-104.
22 +
Preliminary Estimate of the Population of the United States by Age, Sex, and Race, 1970-1981 . Current Population Report Series P-25. US Bureau of Census, 1982;, p 10.
23 +
Bader JL, Li FP, Olmstead PM, et al:  Childhood malignant melanoma: Incidence and etiology . Am J Pediatr Hematol Oncol 1985;;7:341-345.
24 +
Rhodes AR, Melski JW, Sober AJ, et al:  Increased intraepidermal melanocyte frequency and size in dysplastic melanocytic nevi and cutaneous melanoma: A comparative quantitative study of dysplastic melanocytic nevi, superficial spreading melanoma, nevocellular nevi, and solar lentigines . J Invest Dermatol 1983;;80:452-459.
25 +
Greene MH, Clark WH Jr, Tucker MA, et al:  Acquired precursors of cutaneous malignant melanoma . N Engl J Med 1985;;312:91-97.
26 +
Kraemer KH, Greene MH:  Dysplastic nevi and cutaneous melanoma risk . Lancet 1983;;2:1076-1077.
27 +
Greene MH, Clark WH Jr, Tucker MA, et al:  The prospective diagnosis of malignant melanoma in a population at high risk: Hereditary melanoma and the dysplastic nevus syndrome . Ann Intern Med 1985;;102:458-465.
28 +
Rhodes AR, Harrist TJ, Day CL, et al:  Dysplastic melanocytic nevi in histologic association with 234 primary cutaneous melanomas . J Am Acad Dermatol 1983;;9:563-574.
29 +
Clark WH Jr, Elder DE, Guerry DIV, et al:  A study of tumor progression: The precursor lesions of superficial spreading and nodular melanoma . Hum Pathol 1984;;15:1147-1165.
30 +
Bale SJ, Chakravarti A, Greene MH:  Cutaneous malignant melanoma and familial dysplastic nevi: Evidence for autosomal dominance and pleiotropy . Am J Hum Genet 1986;;38:188-196.
31 +
Nordlund JJ, Kirkwood J, Forget BM, et al:  Demographic study of clinically atypical (dysplastic) nevi in patients with melanoma and comparison subjects . Cancer Res 1985;;45:1855-1861.
32 +
Kraemer KH, Tucker M, Tarone R, et al:  Risk of cutaneous melanoma in dysplastic nevus syndrome types A and B . N Engl J Med 1986;;315:1615-1616.
33 +
Kraemer KH, Greene MH:  Dysplastic nevus syndrome: Familial and sporadic precursors of cutaneous melanoma . Dermatol Clin 1985;;3:225-237.
34 +
Crutcher WA, Sagebiel RW:  Prevalence of dysplastic nevi in a community practice . Lancet 1984;;1:729.
35 +
Swerdlow AJ, English J, MacKie RM, et al:  Benign naevi associated with high risk of melanoma . Lancet 1984;;2:168.
36 +
Reynolds P, Austin DF:  Epidemiologic-based screening strategies for malignant melanoma of the skin , in Engstrom PF, Anderson PN, Mortenson LE (eds): Advances in Cancer Control: Epidemiology and Research . New York, Alan R Liss Inc, 1984;, pp 245-254.
37 +
Green A, MacLennon R, Siskind V:  Common acquired nevi and the risk of malignant melanoma . Int J Cancer 1985;;35:297-300.
38 +
Holman CDJ, Armstrong BK:  Pigmentary traits, ethnic origin, benign nevi, and familial history as risk factors for cutaneous malignant melanoma . JNCI 1984;;72:257-266.
39 +
Elwood JM, Williamson C, Stapleton PJ:  Malignant melanoma in relation to moles, pigmentation, and exposure to fluorescent and other lighting sources . Br JCancer 1986;;53:65-74.
40 +
Clark WH, Mihm MC:  Lentigo maligna and lentigo maligna melanoma . Am J Pathol 1969;;55:39-67.
41 +
Wayte DM, Helwig EB:  Melanotic freckle of Hutchinson . Cancer 1968;;21:893-911.
42 +
Weinstock MA, Sober AJ:  Risk of progression of lentigo maligna to lentigo maligna melanoma . Br J Dermatol 1987;;16:303-310.
43 +
Silvers DN:  Focus on melanoma: The therapeutic dilemma of lentigo maligna (Hutchinson's freckle) . J Dermatol Surg Oncol 1972;;2:301-302.
44 +
Walton RG, Jacobs AH, Cox AJ:  Pigmented lesions in newborn infants . Br J Dermatol 1976;;95:389-396.
45 +
Alper J, Holmes LB, Mihm MC:  Birthmarks with serious medical significance: Nevocellular nevi, sebaceous nevi, and multiple cafe-au-lait spots . J Pediatr 1979;;95:696-700.
46 +
Rhodes AR, Wood WC, Sober AJ, et al:  Nonepidermal origin of malignant melanoma associated with a giant congenital nevocellular nevus . Plast Reconstr Surg 1981;;67:782-790.
47 +
Reed WB, Becker SW Sr, Becker SW Jr, et al:  Giant pigmented nevi, melanoma, and leptomeningeal melanocytosis: A clinical and histopathological study . Arch Dermatol 1965;;91:100-119.
48 +
Lanier V, Pickrell K, Georgiade NG:  Congenital giant nevi: Clinical and pathological considerations . Plast Reconstr Surg 1976;;58:48-54.
49 +
Trozak DJ, Rowland WD, Hu F:  Metastatic melanoma in prepubertal children . Pediatrics 1975;;55:191-204.
50 +
Pers M:  Naevus Pigmentosus Giganticus: Indikationer für Operativ Behandling . Ugeskr Laeger 1963;;125:613-620.
51 +
Lorentzen M, Pers M, Brettville-Jensen G:  The incidence of malignant transformation in giant pigmented nevi . Scand J Plast Reconstr Surg 1977;;11:163-167.
52 +
Rhodes AR, Sober AJ, Day CL, et al:  The malignant potential of small congenital nevocellular nevi: An estimate of association based on a histologic study of 234 primary cutaneous melanomas . J Am Acad Dermatol 1982;;60:230-241.
53 +
Illig L, Weidner F, Hundeiker M, et al:  Congenital nevi ≤ 10 cm as precursors to melanoma: 52 cases, a review, and a new conception . Arch Dermatol 1985;;121:1274-1281.
54 +
Elder DE:  The blind men and the elephant: Different views of small congenital nevi . Arch Dermatol 1985;;121:1263-1265.
55 +
 Precursors to malignant melanoma . JAMA 1984;;251:1864-1866.
56 +
Rhodes AR, Slifman NR, Korf BR:  Familial aggregation of small congenital nevomelanocytic nevi . Am J Med Genet 1985;;22:315-326.
57 +
Tucker MA, Boice JD, Hoffman DA:  Second cancer following cutaneous melanoma and cancers of the brain, thyroid, connective tissue, bone, and eye in Connecticut, 1935-1982 . NCI Monogr 1985;;68:161-189.
58 +
Veronesi U, Cascinelli N, Bufalino R:  Evaluation of the risk of multiple primaries in malignant cutaneous melanoma . Tumori 1976;;62:127-130.
59 +
Taylor MR, Guerry D IV, Bondi EE, et al:  Lack of association between intraocular melanoma and cutaneous dysplastic nevi . Am J Ophthalmol 1984;;98:478-482.
60 +
Duggleby WF, Stoll H, Priore RL, et al:  A genetic analysis of melanoma: Polygenetic inheritance as a threshold trait . Am J Epidemiol 1981;;114:63-72.
61 +
Greene MH, Young TI, Clark WH Jr:  Malignant melanoma in renal transplant recipients . Lancet 1981;;1:1196-1199.
62 +
Tucker MA, Misfeldt D, Coleman CN, et al:  Cutaneous malignant melanoma after Hodgkin's disease . Ann Intern Med 1985;;102:37-41.
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Storm HH, Prener A:  Second cancer following lymphatic and hematopoietic cancers in Denmark, 1943-1980 . NCI Monogr 1985;;68:389-410.
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English JSC, Swerdlow AJ, MacKie RM, et al:  Relation between phenotype and banal melanocytic naevi . Br Med J 1987;;294:152-154.
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Holman CDJ, Armstrong BK:  Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun: An analysis separating histogenic types . JNCI 1984;;73:75-82.
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89 +
Rhodes AR:  Melanocytic precursors of cutaneous melanoma , in Fitzpatrick TB, Wick MM, Toda K (eds): Brown Melanoderma: Biology and Diseases of Epidermal Pigmentation . Tokyo, University of Tokyo Press, 1986;, pp 129-147.
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91 +
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Silverberg E, Lubera J:  Cancer statistics, 1987 . CA 1987;;37:2-19.
2 +
Horm JW, Asire AJ, Young JL Jr, et al: SEER Program: Cancer Incidence Mortality in the United States, 1973-1981 , US Dept of Health and Human Services publication (NIH) 85-1837. Bethesda, Md, National Cancer Institute, 1984;.
3 +
Vital Statistics of the United States, 1979 , US Dept of Health and Human Services publication (PHS) 84-1101. National Center for Health Statistics, 1984;, vol 2, pt A,  section 6 , p 8.
4 +
Roush GC, Schymura MJ, Holford TR:  Risk for cutaneous melanoma in recent Connecticut birth cohorts . Am J Public Health 1985;;75:679-682.
5 +
Balch CM, Soong S-J, Milton GW, et al:  Changing trends in cutaneous melanoma over a quarter century in Alabama, USA, and New South Wales, Australia . Cancer 1983;;52:1748-1753.
6 +
Silverberg E:  Cancer statistics . CA 1983;;33:3-26.
7 +
Balch CM, Urist MM, Maddox WA, et al:  Melanoma in the Southern United States: Experience at the University of Alabama in Birmingham , in Balch CM, Milton GW, Shaw HM, et al (eds): Cutaneous Melanoma: Clinical Management and Treatment Results Worldwide . Philadelphia, JB Lippincott, 1985;, pp 397-406.
8 +
Mihm MC Jr, Fitzpatrick TB, Lane-Brown MM, et al:  Early detection of primary cutaneous melanoma: A color atlas . N Engl J Med 1973;;289:989-996.
9 +
Sober AJ, Fitzpatrick TB, Mihm MC, et al:  Early recognition of cutaneous melanoma . JAMA 1979;;242:2795-2799.
10 +
Friedman RJ, Rigel DS, Kopf AW:  Early detection of malignant melanomas: The role of physician examination and self-examination of the skin . CA 1985;;35:130-151.
11 +
Elder DE, Greene MH, Bondi EE, et al:  Acquired melanocytic nevi and melanoma: The dysplastic nevus syndrome , in Ackerman AB (ed): Pathology of Malignant Melanoma . New York, Masson Publishers USA Inc, 1981;, pp 185-215.
12 +
Rhodes AR, Melski JW:  Small congenital nevocellular nevi and the risk of cutaneous melanoma . J Pediatr 1982;;100:219-224.
13 +
Doherty VR, MacKie RM:  Reasons for poor prognosis in British patients with cutaneous malignant melanoma . Br Med J 1986;;292:987-989.
14 +
Rhodes AR, Sober AJ, Mihm MC Jr, et al:  Possible risk factors for primary cutaneous malignant melanoma . Clin Res 1980;;28:252A.
15 +
Swerdlow AJ, English J, MacKie RM, et al:  Benign melanocytic nevi as a risk factor for malignant melanoma . Br Med J 1986;;292:1555-1559.
16 +
Rhodes AR:  Pigmented birthmarks and precursor melanocytic lesions of cutaneous melanoma identifiable in childhood . Pediatr Clin North Am 1983;;30:435-463.
17 +
Rhodes AR:  Melanocytic precursors of cutaneous melanoma: Estimated risks and guidelines for management . Med Clin North Am 1986;;70:3-37.
18 +
Rhodes AR:  Neoplasms: Benign neoplasias, hyperplasias, and dysplasias of melanocytes , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 3. New York, McGraw-Hill International Book Co, 1986;, pp 877-946.
19 +
Sober AJ, Day CL, Kopf AW, et al:  Detection of'thin' primary melanomas . CA 1983;;33:160-163.
20 +
Wick MM, Sober AJ, Fitzpatrick TB, et al:  Clinical characteristics of early cutaneous melanoma . Cancer 1980;;45:2684-2686.
21 +
Houghton A, Flannery J, Viola MV:  Malignant melanoma in Connecticut and Denmark . Int J Cancer 1980;;25:95-104.
22 +
Preliminary Estimate of the Population of the United States by Age, Sex, and Race, 1970-1981 . Current Population Report Series P-25. US Bureau of Census, 1982;, p 10.
23 +
Bader JL, Li FP, Olmstead PM, et al:  Childhood malignant melanoma: Incidence and etiology . Am J Pediatr Hematol Oncol 1985;;7:341-345.
24 +
Rhodes AR, Melski JW, Sober AJ, et al:  Increased intraepidermal melanocyte frequency and size in dysplastic melanocytic nevi and cutaneous melanoma: A comparative quantitative study of dysplastic melanocytic nevi, superficial spreading melanoma, nevocellular nevi, and solar lentigines . J Invest Dermatol 1983;;80:452-459.
25 +
Greene MH, Clark WH Jr, Tucker MA, et al:  Acquired precursors of cutaneous malignant melanoma . N Engl J Med 1985;;312:91-97.
26 +
Kraemer KH, Greene MH:  Dysplastic nevi and cutaneous melanoma risk . Lancet 1983;;2:1076-1077.
27 +
Greene MH, Clark WH Jr, Tucker MA, et al:  The prospective diagnosis of malignant melanoma in a population at high risk: Hereditary melanoma and the dysplastic nevus syndrome . Ann Intern Med 1985;;102:458-465.
28 +
Rhodes AR, Harrist TJ, Day CL, et al:  Dysplastic melanocytic nevi in histologic association with 234 primary cutaneous melanomas . J Am Acad Dermatol 1983;;9:563-574.
29 +
Clark WH Jr, Elder DE, Guerry DIV, et al:  A study of tumor progression: The precursor lesions of superficial spreading and nodular melanoma . Hum Pathol 1984;;15:1147-1165.
30 +
Bale SJ, Chakravarti A, Greene MH:  Cutaneous malignant melanoma and familial dysplastic nevi: Evidence for autosomal dominance and pleiotropy . Am J Hum Genet 1986;;38:188-196.
31 +
Nordlund JJ, Kirkwood J, Forget BM, et al:  Demographic study of clinically atypical (dysplastic) nevi in patients with melanoma and comparison subjects . Cancer Res 1985;;45:1855-1861.
32 +
Kraemer KH, Tucker M, Tarone R, et al:  Risk of cutaneous melanoma in dysplastic nevus syndrome types A and B . N Engl J Med 1986;;315:1615-1616.
33 +
Kraemer KH, Greene MH:  Dysplastic nevus syndrome: Familial and sporadic precursors of cutaneous melanoma . Dermatol Clin 1985;;3:225-237.
34 +
Crutcher WA, Sagebiel RW:  Prevalence of dysplastic nevi in a community practice . Lancet 1984;;1:729.
35 +
Swerdlow AJ, English J, MacKie RM, et al:  Benign naevi associated with high risk of melanoma . Lancet 1984;;2:168.
36 +
Reynolds P, Austin DF:  Epidemiologic-based screening strategies for malignant melanoma of the skin , in Engstrom PF, Anderson PN, Mortenson LE (eds): Advances in Cancer Control: Epidemiology and Research . New York, Alan R Liss Inc, 1984;, pp 245-254.
37 +
Green A, MacLennon R, Siskind V:  Common acquired nevi and the risk of malignant melanoma . Int J Cancer 1985;;35:297-300.
38 +
Holman CDJ, Armstrong BK:  Pigmentary traits, ethnic origin, benign nevi, and familial history as risk factors for cutaneous malignant melanoma . JNCI 1984;;72:257-266.
39 +
Elwood JM, Williamson C, Stapleton PJ:  Malignant melanoma in relation to moles, pigmentation, and exposure to fluorescent and other lighting sources . Br JCancer 1986;;53:65-74.
40 +
Clark WH, Mihm MC:  Lentigo maligna and lentigo maligna melanoma . Am J Pathol 1969;;55:39-67.
41 +
Wayte DM, Helwig EB:  Melanotic freckle of Hutchinson . Cancer 1968;;21:893-911.
42 +
Weinstock MA, Sober AJ:  Risk of progression of lentigo maligna to lentigo maligna melanoma . Br J Dermatol 1987;;16:303-310.
43 +
Silvers DN:  Focus on melanoma: The therapeutic dilemma of lentigo maligna (Hutchinson's freckle) . J Dermatol Surg Oncol 1972;;2:301-302.
44 +
Walton RG, Jacobs AH, Cox AJ:  Pigmented lesions in newborn infants . Br J Dermatol 1976;;95:389-396.
45 +
Alper J, Holmes LB, Mihm MC:  Birthmarks with serious medical significance: Nevocellular nevi, sebaceous nevi, and multiple cafe-au-lait spots . J Pediatr 1979;;95:696-700.
46 +
Rhodes AR, Wood WC, Sober AJ, et al:  Nonepidermal origin of malignant melanoma associated with a giant congenital nevocellular nevus . Plast Reconstr Surg 1981;;67:782-790.
47 +
Reed WB, Becker SW Sr, Becker SW Jr, et al:  Giant pigmented nevi, melanoma, and leptomeningeal melanocytosis: A clinical and histopathological study . Arch Dermatol 1965;;91:100-119.
48 +
Lanier V, Pickrell K, Georgiade NG:  Congenital giant nevi: Clinical and pathological considerations . Plast Reconstr Surg 1976;;58:48-54.
49 +
Trozak DJ, Rowland WD, Hu F:  Metastatic melanoma in prepubertal children . Pediatrics 1975;;55:191-204.
50 +
Pers M:  Naevus Pigmentosus Giganticus: Indikationer für Operativ Behandling . Ugeskr Laeger 1963;;125:613-620.
51 +
Lorentzen M, Pers M, Brettville-Jensen G:  The incidence of malignant transformation in giant pigmented nevi . Scand J Plast Reconstr Surg 1977;;11:163-167.
52 +
Rhodes AR, Sober AJ, Day CL, et al:  The malignant potential of small congenital nevocellular nevi: An estimate of association based on a histologic study of 234 primary cutaneous melanomas . J Am Acad Dermatol 1982;;60:230-241.
53 +
Illig L, Weidner F, Hundeiker M, et al:  Congenital nevi ≤ 10 cm as precursors to melanoma: 52 cases, a review, and a new conception . Arch Dermatol 1985;;121:1274-1281.
54 +
Elder DE:  The blind men and the elephant: Different views of small congenital nevi . Arch Dermatol 1985;;121:1263-1265.
55 +
 Precursors to malignant melanoma . JAMA 1984;;251:1864-1866.
56 +
Rhodes AR, Slifman NR, Korf BR:  Familial aggregation of small congenital nevomelanocytic nevi . Am J Med Genet 1985;;22:315-326.
57 +
Tucker MA, Boice JD, Hoffman DA:  Second cancer following cutaneous melanoma and cancers of the brain, thyroid, connective tissue, bone, and eye in Connecticut, 1935-1982 . NCI Monogr 1985;;68:161-189.
58 +
Veronesi U, Cascinelli N, Bufalino R:  Evaluation of the risk of multiple primaries in malignant cutaneous melanoma . Tumori 1976;;62:127-130.
59 +
Taylor MR, Guerry D IV, Bondi EE, et al:  Lack of association between intraocular melanoma and cutaneous dysplastic nevi . Am J Ophthalmol 1984;;98:478-482.
60 +
Duggleby WF, Stoll H, Priore RL, et al:  A genetic analysis of melanoma: Polygenetic inheritance as a threshold trait . Am J Epidemiol 1981;;114:63-72.
61 +
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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BMJ 2010;341:c5893-c1494.
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