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The occurrence of Hutchinson's melanotic freckle in the floor of the mouth is reported in a patient who had previously undergone a partial resection of the mandible for melanoma arising in the labial alveolar mucosa. The present case appears to be the fourth reported instance of a melanotic freckle of oral mucosa. In 2 of the 3 previously published reports, the morphological features were not illustrated or described. In the third, a black-brown pigmented area had been present for many years and was followed by the development of melanoma in the same area. In the case histories of several of the reports of intra-oral melanoma reviewed by the authors, it was stated that mucosal pigmentation had been present for a considerable period of time before the melanoma developed. This suggests the possibility that Hutchinson's melanotic freckle may have been present but not recognized.

Benign melanocytic lesions include lentigo, ephelid (freckle), pigmented nevus, sacral spot, blue nevus, and combined nevus and blue nevus. Malignant melanocytic lesions are melanomas, which arise from melanocytes at the epidermodermal junction, or, rarely, from blue nevi. They usually originate in brown plaques known as lentigo maligna, in pigmented nevi, or in normal skin. Melanoma is diagnosed clinically in less than 50 per cent of instances. Biopsy is therefore of great importance, since practically all melanoma can be cured by adequate early resection.

Melanotic freckle is a pigmented, precancerous lesion that is clinically distinctive, sometimes difficult to interpret histopathologically, and which presents a problem in histological diagnosis, prognosis, and in treatment. It progresses slowly, sometimes to a malignant tumor stage (superficial melanocarcinoma) which may be indistinguishable from malignant melanoma, and yet its prognosis as to metastasis, morbidity, and mortality is comparatively favorable. Dermatologic literature contains several comprehensive reports of this unusual entity since its original description by Hutchinson. 1 Noteworthy are those of Dubreuilh, 2,3 Meischer, 4,5 Justitz, 6 and more recently, Klauder and Beerman. 7 There have been two hundred cases reported in all. The purpose of this presentation is to record twelve additional cases seen in private practice and clinic practice. Nomenclature Melanotic freckle has been described under many names, such as senile freckle, infective melanotic freckle, melanose circonscrite precancereuse, lentigo malin des vieillards

IT HAS been stated that diagnosis of cutaneous malignant melanoma is comparable to writing the death certificate of the patient. An exception to this gloomy prognosis is the malignant melanoma arising from the pigmented lesion that Hutchinson * first described as senile freckle or infective melanotic freckle, later termed by Darier and by Dubreuilh lentigo malin des vieillards and still later by Dubreuilh 3 melanose circonscrite precancereuse . We believe this disease is too briefly discussed in the usual textbooks of dermatology to afford comprehensive understanding of the pathologic process and differentiation from the more serious malignant melanoma arising from the pigmented dermoepidermal nevus (junction type nevus). Such differentiation is of importance from the standpoint of prognosis and of treatment. Discussion of these features is the object of this report. Since Hutchinson's * brief description of the disease relatively few comprehensive reports have been published. Notable exceptions