... Correlations, 2nd edn, 1996, with permission from Elsevier Science.42 )Figure 8.8. Pigmented nodular melanoma. (Reprinted from PH McKee. Pathology of the Skin with Clinical Correlations, 2nd edn, ... pruritic but are often asymptomatic. As with all unusual and refractory warty lesions, they are best removed surgically to establish a diag-nosis. While the histological changes can resemble ... first-line therapy with equally good response rates. 12 Intractable or recurrent disease is best managed by surgical excision, with extensive lesions often requiring additional skin grafting....