Causation and melanoma classification
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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.
KeywordsMelanoma Classification Causation Mechanism
This paper was originally presented at the Philosophy of Medicine Roundtable event at the Erasmus Institute for Philosophy and Economics (EIPE) in Rotterdam on October 19, 2009. I am grateful to all those whose penetrating questions—in particular, of Raffaella Campaner, Jan Vandenbroucke, and three anonymous reviewers—helped to shape this paper.
- 2.Laennec, R.T.H. 1806. Sur les melanoses. Bulletin de la Faculte de Medecine de Paris 1: 24–26.Google Scholar
- 4.Norris, W. 1820. A case of fungoid disease. Edinburgh Medical and Surgical Journal 16: 562–565.Google Scholar
- 5.Carswell, R. 1838. Pathological anatomy. London: Longman.Google Scholar
- 7.Rolleston, H.D. 1899. A clinical lecture on secondary melanotic sarcoma of the liver. Lancet 153(3950): 1273–1275.Google Scholar
- 9.Anonymous. 1939. Melanoma. Lancet 234(6070): 1376.Google Scholar
- 11.Cancer Council Australia. 2010. Melanoma. Cancer Council Australia. http://www.cancer.org.au/aboutcancer/cancertypes/melanoma.htm. Accessed 1 Dec 2009.
- 14.Williams, H.C. 2003. Evidence-based dermatology. London: BMJ Books.Google Scholar
- 19.Clark, W.H., L. From, E.A. Bernardino, and M.C. Mihm. 1969. The histogenesis and biologic behavior of primary human malignant melanomas of the skin. Cancer Research 29(3): 705–727.Google Scholar
- 22.World Health Organization. 2007. International statistical classification of diseases and related health problems. 10th revision. Geneva: World Health Organization.Google Scholar
- 26.Trapl, J., L. Palecek, J. Ebel, and M. Kucera. 1966. Tentative new classification of melanoma of the skin. Acta Dermato-Venereologica 46: 443–446.Google Scholar
- 29.Craver, C.F. 2007. Explaining the brain: Mechanisms and the mosaic unity of neuroscience. Oxford: Clarendon Press.Google Scholar
- 31.Campaner, R. 2011. Understanding mechanisms in the health sciences. Theoretical Medicine and Bioethics 32(1).Google Scholar
- 37.National Institute for Health and Clinical Excellence. 2009. Breast cancer (early & locally advanced). London: National Institute for Health and Clinical Excellence. http://guidance.nice.org.uk/CG80/Guidance/pdf/English.
- 38.Kerlikowske, K., A.M. Molinaro, M.L. Gauthier, et al. 2010. Biomarker expression and risk of subsequent tumors after initial ductal carcinoma in situ diagnosis. Journal of the National Cancer Institute 102(9): 627–637.Google Scholar