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The order of things and the classification of melanoma

1 Editorial Melanoma is a fascinating disease. It appears in a myriad of forms. No two melanomas look alike; every melanoma is unique morphologically. Like other biologic phenomena it is highly complex and diverse in its forms of appearance. Scientists attempt to bring order to the diversity of biologic phenomena by defining groups on the basis of shared characteristics and by giving names to these groups. What we call knowledge or, if one prefers a more elevated word, " truth, " is synonymous with being able to classify, name, and order phenomena correctly. In the 18th century the biologist Carl Linné established a universally accepted convention for the naming of organisms. According to Linné, a tiger is a species (Panthera tigris) that belongs to the genus " panther, " which is included in the family of Felidae, which are part of the order Carnivora, which belong to the class Mamma-lia, which is included in the phylum Chordata, which finally belongs to the kingdom Animalia. It was not by accident that Linné's classification was hierarchic and based on morpho-logic (visible) criteria. In his influential book The Order of Things*, the great French historian and philosopher Michel Foucault advanced the hypothesis that all periods of history have possessed specific conditions of " truth " that constituted what was acceptable. Scientific " truth " is nothing more than a mirror of mainstream thinking of an era and its power relations. The specific conditions of the 18th century presupposed a hierarchic classification and the sense of vision was so important for life sciences in those days that a biologist could be everything, but not blind (which is still true today for dermatologists and dermatopathologists). Classifying diseases is not fundamentally different from classifying organisms. The classification of neoplasms as set forth by Virchow in the 19th century is also hierarchic and based on morphologic (in this case histogenetic) characteristics. According to the WHO classification there are four major subtypes of melanoma: superficial spreading mela-noma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Many arguments have been brought up against this classification. It was criticized for being inconsistent, illogical and practically useless. All these arguments fail to take into account that the validity and the spread of a given scientific point of view does not so much depend on constituency, logic, and practical value as on the prevailing (" mainstream ") thinking at a given …