A lost piece of melanoma history

Laennec's melanosis: The first published description of metastatic melanoma

Melanomas are a common skin condition in Australia. The authors decided to examine the history of melanomas and its metastases with particular reference to the description of Laennec and the controversy between him and his teacher Dupuytren, who challenged his pupil as to who was the first to describe melanomatous metastases to the lungs. The rivalry between teacher and student continued, with each describing a similar system of pathological classification.

A brief history of melanoma: from mummies to mutations

In recent years, melanoma research has undergone a renaissance. What was once viewed, at least in the metastatic setting, as an intractable and untreatable disease is now revealing its molecular weaknesses. 2011 was a landmark year for melanoma therapy, with two new agents, the anti-CTLA4 antibody ipilimumab and the BRAF inhibitor vemurafenib, shown to confer a survival benefit in randomized phase III clinical trials. Overlooked in the recent flurry of interest that has accompanied the development of these drugs, melanoma is in fact an ancient disease that has long frustrated attempts at therapeutic interventions. In this article, we trace the history of melanoma: from the earliest known cases of melanoma in pre-Colombian South America, through the explorations of the Victorian anatomists right up to the molecular biology revolution of the 20th century that allowed for the identification of the key driving events required for melanomagenesis. We further outline how observations about melanoma heterogeneity, first made over 190 years ago, continue to drive our efforts to reduce melanoma to the level of a chronic, manageable disease and ultimately to cure it entirely.

Causation and melanoma classification

In this article, I begin by giving a brief history of melanoma causation. I then discuss the current manner in which malignant melanoma is classified. In general, these systems of classification do not take account of the manner of tumour causation. Instead, they are based on phenomenological features of the tumour, such as size, spread, and morphology. I go on to suggest that misclassification of melanoma is a major problem in clinical practice. I therefore outline an alternative means of classifying these tumours based on causal factors. By analogy with similar systems that have recently emerged for other cancers, I suggest that this causal classification is likely to be both workable and helpful, even in the absence of a full causal-mechanistic understanding of the aetiology of the tumour.

The role of ultraviolet radiation in melanomagenesis

The role of ultraviolet radiation (UV) in the pathogenesis has been discussed controversially for many decades. Studies in mice (SCID, HGF/SF, SV40T) which develop malignant melanoma, show a role of UVB in melanomagenesis. In contrast to this, the role of UVA is less clear. We will review the recent in vitro and in vivo data in support of the hypothesis that UVA is also involved in the development of malignant melanoma. The role of UVA in p53 activation, apoptosis, cell cycle arrest and photoproduct formation is discussed.

Rene Theophile Hyacinthe Laënnec (1781-1826): the man behind the stethoscope

Rene Theophile Hyacinthe Laënnec (1781-1826) was a French physician who, in 1816, invented the stethoscope. Using this new instrument, he investigated the sounds made by the heart and lungs and determined that his diagnoses were supported by the observations made during autopsies. Laënnec later published the first seminal work on the use of listening to body sounds, De L'auscultation Mediate (On Mediate Auscultation). Laënnec is considered the father of clinical auscultation and wrote the first descriptions of bronchiectasis and cirrhosis and also classified pulmonary conditions such as pneumonia, bronchiectasis, pleurisy, emphysema, pneumothorax, phthisis and other lung diseases from the sounds he heard with his invention. Laënnec perfected the art of physical examination of the chest and introduced many clinical terms still used today.