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Logic:
Logic is the application of argument to the solution of problems. It requires a system in which positions are defined. Having established such a system, observations then are to be accommodated in a manner which will conform to the positions; in this approach, primacy becomes a problem; words, not images, tend to be given precedence. The Queen in “Alice in Wonderland” had her own peculiar and contrary logic; it was appropriate for her table of truths. The premises of logic need not be congruent with those obtained by the application of reason. Logic, in its argumentative approach, leads to concrete conclusions. Another, or alternate, system of logic will be required, if the first is to be refuted. In Pathology, logic is rampant in the current literature. Tautologies and logic, with all their short-comings, are the basic components in the practice of surgical pathology.
In the application of immunohistochemistry to the practice of surgical pathology, a truth table is required. In the interpretation of results (putting values on the functions), a play on words, and a willingness to accept the assigned values as having diagnostic relevance introduces biases; in a sense, from the biases, a system of logic can be - has been - structured.
Logic is not the same as reasoning. Reasoning involves intellect, and a less measurable attribute, intuition. Ackerman’s widely accepted system of logic (for some reason less questioned in Europe than in America) eliminates the need to recognize intermediate steps in neoplasia.
Biologic natural phenomena are infinitely diverse but, with Ackerman’s system of logic, finiteness in word, if not in deed, is at hand. Man has had some success in exposing nature’s secrets. In such expositions, success (by human criteria) is found when results are beneficial to man. In this approach, it is with logic, more than reason, that truth functions can be related to therapeutic decisions. In logic, constraints are basic; an open mind is not a requisite. In reasoning, an open mind is a requisite. Perhaps, in Sophie Spitz’s studies of “Spitz lesions,” the less measurable attribute (i.e., intuition) led her to characterize the lesion as a variant melanoma rather than a nevus. She may have had a purpose in characterizing the lesion as a variant melanoma.
A reader, who is also a surgical pathologist, might consider the impact of Ackerman’s logic, if applied to an organ system other than the skin. Consider, for example, what the classification of ovarian epithelial tumors would become, if such logic were popularized; there would be no borderline category. I suppose a category of intraepithelial carcinoma might survive, but it seems to me that at one time Ackerman objected to a concept of carcinoma-in-situ (but not melanoma-in-situ?).
To return to a time in which proliferating pilar tumors were lost in the general category of carcinoma of the skin, there were reasons why proliferating pilar tumor was given separate recognition; they had to do with patterns of growth, and with clinical follow-up. The same characteristics might be cited for the separation of actinic keratoacanthoma from common carcinoma; although, comparisons with animal experiments probably were irrelevant for actinic variants. What might be the implications of a concept which equates epithelial mucinosis in association with banal lymphoid infiltrates with a diagnosis of lymphoma?
If we select a system of logic which promotes the premise that an intermediate state is commonly represented in melanocytic neoplasia (and in most progressive neoplastic systems), we can cite morphologic candidates in which degree of atypia, monotony of cell types, and morphologic features are combined in intermediate patterns (in this approach, a stage of neoplasia is intermediate; this characterization should not be equated with grade of neoplasia); in this characterization, metastasizing intermediate lesions, particularly in the Spitz category, would appear to be mostly low-grade lesions.
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