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To the Editor.—In their Rational Clinical Examination entitled "Does This Patient Have a Mole or a Melanoma?" Drs Whited and Grichnik¹ fail to realize that the basis of their arguments can only be as strong as the most flawed information in their analysis. Their discussion demonstrates that they fully realize the limitations of the clinical examination, but they fail to acknowledge that the "gold standard" of their study, microscopic examination of the biopsy specimen, has similar limitations. Without the certainty of a true gold standard of biological behavior, all their inferences are suspect.

A gold standard is a relatively irrefutable standard that constitutes recognized and accepted evidence that a certain disease exists. A diagnostic gold standard needs to be validated by biological behavior. Histopathologic examination of advanced tumors earlier this century was consistently validated by aggressive biological behavior of the tumors. However, there is evidence that the application of . . . [Full Text of this Article]