Melanoma and History of the concept of creativity: Difference between pages

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:''This article is about the '''History of creativity'''. For the main article, see '''[[Creativity]]'''.''
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{{TOCright}}The ways in which societies have perceived the [[concept]] of [[creativity]] have changed throughout history, as has the [[terminology|term]] itself. The [[ancient Greece|ancient Greek]] concept of [[art]] (in Greek, "''techne''" — the root of "technique" and "technology"), except for [[poetry]], involved not freedom of action but subjection to ''rules''. In [[ancient Rome|Rome]], the Greek concept was partly shaken, and [[visual art]]ists were viewed as sharing, with poets, [[imagination]] and [[artistic inspiration|inspiration]].
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Under [[medieval]] [[Christianity]], the [[Latin]] "''creatio''" came to designate [[God]]'s act of "''[[creatio ex nihilo]]''" ("creation from nothing"); thus "''creatio''" ceased to apply to human activities. The Middle Ages, however, went even further than antiquity, when they revoked poetry's exceptional status: it, too, was an art and therefore craft and not creativity.
'''Melanoma''' is a [[malignant]] [[tumor]] of [[melanocyte]]s which are found predominantly in skin but also in the [[bowel]] and the [[eye]] (see [[uveal melanoma]]). It is one of the rarer types of [[skin cancer]] but causes the majority of skin cancer related deaths. Malignant melanoma is a serious type of skin cancer. It is due to uncontrolled growth of pigment cells, called melanocytes.<ref>[http://www.nlm.nih.gov/medlineplus/news/fullstory_34983.html Melanoma Death Rate Still Climbing]</ref><ref>[http://seer.cancer.gov/statfacts/html/melan.html Cancer Stat Fact Sheets]</ref> Despite many years of intensive laboratory and clinical research, the sole effective cure is surgical resection of the primary tumor before it achieves a [[Breslow thickness]] greater than 1&nbsp;mm.


[[Renaissance]] men sought to give voice to their sense of their freedom and creativity. The first to apply the word, "creativity," however, was the 17th-century [[Poland|Polish]] poet, [[Maciej Kazimierz Sarbiewski]] — but he applied it only to poetry. For over a century and a half, the idea of human creativity met with resistance, due to the expression "creation" being reserved for creation "from nothing."
Around 160,000 new cases of melanoma are diagnosed worldwide each year, and it is more frequent in males and caucasians.<ref name="Stat">Ries LAG, et al, eds. SEER Cancer Statistics Review, 1975-2000. Bethesda, MD: National Cancer Institute; 2003: Tables XVI-1-9.</ref> It is more common in caucasian populations living in sunny climates than other groups.<ref>{{cite journal | author = Parkin D, Bray F, Ferlay J, Pisani P | title = Global cancer statistics, 2002 | journal = CA Cancer J Clin | volume = 55 | issue = 2 | pages = 74–108 | year = | pmid = 15761078}}''[http://caonline.amcancersoc.org/cgi/content/full/55/2/74 Full text]''</ref>
According to a [[WHO]] Report about 48,000 melanoma related deaths occur worldwide per year.<ref name="who1">Lucas, R. Global Burden of Disease of Solar Ultraviolet Radiation, Environmental Burden of Disease Series, July 25, 2006; No. 13. News release, World Health Organization</ref>


In the [[19th century]], art took its revenge: now not only was it recognized as creativity, but ''it alone'' was. When later, at the turn of the [[20th century]], there began to be discussion as well of creativity in the [[sciences]] and in [[nature]], this was taken as the transference, to the sciences and to nature, of concepts proper to art.
Malignant melanoma accounts for 75 percent of all deaths associated with skin cancer.<ref>[http://www.aafp.org/afp/20000715/357.html Treatment of Skin Cancer]</ref>


==Term and concept==
The treatment includes surgical removal of the tumor; [[adjuvant]] treatment; [[chemotherapy|chemo-]] and [[Cancer immunotherapy|immunotherapy]], or [[radiation therapy]].
[[Image:Platon-2.jpg|thumb|left|70px|[[Plato]].]]
The [[ancient Greeks]] had no terms corresponding to "to create" or "creator." The expression "''poiein''" ("to make") sufficed. And even that was not extended to [[art]] in general, but only to ''poiesis'' ([[poetry]]) and to the ''poietes'' ([[poet]], or "maker") who ''made'' it. [[Plato]] asks in ''[[The Republic]]'', "Will we say, of a painter, that he makes something?" and answers, "Certainly not, he merely [[mimesis|imitates]]." To the ancient Greeks, the concept of a creator and of creativity implied freedom of action, whereas the Greeks' concept of art involved subjection to laws and rules. Art (in [[Greek language|Greek]], "''techne''") was "the making of things, according to rules." It contained no creativity, and it would have been — in the Greeks' view — a bad state of affairs if it ''had''.<ref>[[Władysław Tatarkiewicz]], ''A History of Six Ideas: an Essay in Aesthetics'', p. 244.</ref>


This understanding of art had a distinct premise: [[Nature]] is [[perfection|perfect]] and is subject to laws, therefore man ought to discover its laws and submit to them, and not seek freedom, which will deflect him from that ''optimum'' which he can attain. The artist was a [[discovery (observation)|discoverer]], not an [[inventor]].<ref>Tatarkiewicz, p. 245.</ref>
==History==
Although melanoma is not a new disease, evidence for its occurrence in antiquity is rather scarce. However, one example lies in a 1960s examination of nine [[Peru]]vian [[Inca Empire|Inca]] mummies, [[radiocarbon]] dated to be approximately 2400 years old, which showed apparent signs of melanoma: melanotic masses in the skin and diffuse metastases to the bones.<!--
--><ref name="urteaga">{{cite journal | author = Urteaga O, Pack G | title = On the antiquity of melanoma | journal = Cancer | volume = 19 | issue = 5 | pages = 607–10 | year = 1966 | pmid = 5326247 | doi = 10.1002/1097-0142(196605)19:5<607::AID-CNCR2820190502>3.0.CO;2-8}}</ref>


The sole exception to this Greek view — a ''great'' exception — was [[poetry]]. The poet made new things — brought to life a new world — while the [[art|artist]] merely ''imitated''. And the poet, unlike the artist, was ''not'' bound by laws. There were no terms corresponding to "creativity" or "creator," but in reality the poet was understood to be one who creates. And only he was so understood. In [[music]], there was no freedom: melodies were prescribed, particularly for ceremonies and entertainments, and were known tellingly as "''nomoi''" ("laws"). In the [[visual arts]], freedom was limited by the [[Body proportions|proportions]] that [[Polyclitus (sculptor)|Polyclitus]] had established for the human frame, and which he called "the canon" (meaning, "measure"). [[Plato]] argued in ''[[Timaeus]]'' that, to execute a good work, one must contemplate an eternal model. Later the [[Roman Republic|Roman]], [[Cicero]], would write that art embraces those things "of which we have knowledge" ("''quae sciuntur''").<ref>Tatarkiewicz, p. 245.</ref>
[[John Hunter (surgeon)|John Hunter]] is reported to be the first to operate on metastatic melanoma in [[1787]]. Although not knowing precisely what it was, he described it as a "cancerous fungous excrescence". The excised tumor was preserved in the [[Royal College of Surgeons of England#Hunterian and Wellcome Museums|Hunterian Museum]] of the [[Royal College of Surgeons of England]]. It was not until [[1968]] that microscopic examination of the specimen revealed it to be an example of metastatic melanoma.<!--
[[Image:Quintus Horatius Flaccus.jpg|thumb|left|70px|[[Horace]].]]
--><ref name=bodenham">{{cite journal | author = Bodenham D | title = A study of 650 observed malignant melanomas in the South-West region | journal = Ann R Coll Surg Engl | volume = 43 | issue = 4 | pages = 218–39 | year = 1968 | pmid = 5698493}}</ref>
Poets saw things differently. Book I of the ''[[Odyssey]]'' asks, "Why forbid the singer to please us with singing ''as he himself will?''" [[Aristotle]] had doubts as to whether poetry was imitation of reality, and as to whether it required adherence to truth: it was, rather, the realm of that "which is neither true nor false."<ref>Tatarkiewicz, pp. 245–46.</ref>


In [[Rome]], these Greek concepts were partly shaken. [[Horace]] wrote that not only poets but painters as well were entitled to the privilege of daring whatever they wished to ("''quod libet audendi''"). In the declining period of antiquity, [[Philostratus]] wrote that "one can discover a similarity between [[poetry]] and [[art]] and find that they have [[imagination]] in common." [[Callistratos]] averred that "Not only is the art of the [[poet]]s and [[prose|prosaist]]s inspired, but likewise the hands of [[sculptor]]s are gifted with the blessing of divine [[inspiration]]." This was something new: [[classical Greece|classical Greeks]] had not applied the [[concept]]s of [[imagination]] and [[inspiration]] to the [[visual arts]] but had restricted them to [[poetry]]. [[Latin]] was richer than [[Greek language|Greek]]: it had a term for "creating" ("''creatio''") and for "''creator''," and had ''two'' expressions — "''facere''" and "''creare''" — where Greek had but one, "''poiein''." Still, the two Latin terms meant much the same thing.<ref>Tatarkiewicz, p. 246.</ref>
The French physician [[René Laennec]] was the first to describe melanoma as a disease entity. His report was initially presented during a lecture for the Faculté de Médecine de Paris in [[1804]] and then published as a bulletin in [[1806]].<!--
--><ref name="laennec">{{cite journal | author = Laennec RTH | year = 1806 | title = Sur les melanoses | journal = Bulletin de la Faculte de Medecine de Paris | volume = 1 | pages = 24–26}}</ref>
The first English language report of melanoma was presented by an English general practitioner from Stourbridge, William Norris in [[1820]].<ref name="norris1"> Norris, W. ''A case of fungoid disease.'', Edinb. Med. Surg. 1820, 16: 562-565.</ref> In his later work in 1857 he remarked that there is a familial predisposition for development of melanoma (''Eight Cases of Melanosis with Pathological and Therapeutical Remarks on That Disease'').


A fundamental change, however, came in the [[Christianity|Christian]] period: "''creatio''" came to designate [[God]]'s act of "creation from nothing" ("''creatio ex nihilo''"). "''Creatio''" thus took on a different meaning than "''facere''" ("to make"), and ceased to apply to human functions. As the [[6th century|6th-century]] Roman official and literary figure [[Cassiodorus]] wrote, "things made and created differ, for we can make, who cannot create."<ref>Tatarkiewicz, p. 247.</ref>
The first formal acknowledgment of advanced melanoma as untreatable came from [[Samuel Cooper (surgeon)|Samuel Cooper]] in 1840. He stated that the only chance for benefit depends upon the early removal of the disease ...'<ref name="cooper">{{cite book | last = Cooper | first = Samuel | title = First lines of theory and practice of surgery | publisher = Longman, Orme, Brown, Green and Longman | date = 1840 | location = London}}</ref> More than one and a half centuries later this situation remains largely unchanged.


Alongside this new, [[religion|religious]] interpretation of the expression, there persisted the ancient view that art is not a domain of creativity. This is seen in two early and influential Christian writers, [[Pseudo-Dionysius]] and [[Augustine of Hippo|St. Augustine]]. Later [[medieval]] men such as [[Hraban the Moor]], and [[Robert Grosseteste]] in the [[13th century]], thought much the same way. The [[Middle Ages]] here went even further than [[classical antiquity|antiquity]]; they made no exception of poetry: it too had its rules, was an [[art]], and was therefore [[craft]] and not creativity.<ref>Tatarkiewicz, p. 247.</ref>
In 1956, Australian professor Henry Oliver Lancaster discovered that melanomas were directly associated with [[latitude]] (ie, intensity of [[sunlight]]); and that exposure to the sun was a very high factor in the development of the cancer{{Fact|date=July 2007}}.


All this changed in modern times. [[Renaissance]] men had a sense of their own independence, freedom and creativity, and sought to give voice to this sense of independence and creativity. The philosopher [[Marsilio Ficino]] wrote that the artist "thinks up" ("''excogitatio''") his works; the theoretician of architecture and painting, [[Leon Battista Alberti]], that he "preordains" ("''preordinazione''"); [[Raphael]], that he shapes a painting according to his idea; [[Leonardo da Vinci]], that he employs "shapes that do not exist in nature"; [[Michelangelo]], that the artist realizes his vision rather than imitating nature; [[Giorgio Vasari]], that "nature is conquered by art"; the Venetian art theoretician, [[Paolo Pino]], that painting is "inventing what is not"; [[Paolo Veronese]], that painters avail themselves of the same liberties as do poets and madmen; [[Federico Zuccari]] ([[1542]]-[[1609]]), that the artist shapes "a new world, new paradises"; [[Cesare Cesariano]] ([[1483]]-[[1541]]), that architects are "demi-gods." Among [[musician]]s, the [[Holland|Dutch]] composer and musicologist [[Jan Tinctoris]] ([[1446]]-[[1511]]) demanded novelty in what a composer did, and defined a composer as "one who produces ''new'' songs."<ref>Tatarkiewicz, pp. 247–48.</ref>
==Epidemiology & Causes==
[[Image:Sarbiewski.gif|thumb|left|70px|[[Maciej Kazimierz Sarbiewski|Sarbiewski]].]]
Still more emphatic were those who wrote about [[poetry]]: [[G.P. Capriano]] held ([[1555]]) that the poet's invention springs "from nothing." [[Francesco Patrizi]] ([[1586]]) saw poetry as "fiction," "shaping," "transformation."<ref>Tatarkiewicz, p. 248.</ref>


Finally, at long last, someone ventured to use the word, "creation." He was the [[17th century|17th-century]] [[Poland|Polish]] poet and theoretician of poetry, [[Maciej Kazimierz Sarbiewski]] ([[1595]]-[[1640]]), known as "the last Latin poet." In his treatise, ''De perfecta poesi'', he not only wrote that a poet "invents," "after a fashion builds," but also that the poet "''creates anew''" ("''de novo creat''"). Sarbiewski even added: "in the manner of God" ("''instar Dei''").<ref>Tatarkiewicz, p. 248.</ref>
Generally, an individual's risk for developing melanoma depends on two groups of factors: intrinsic and environmental.<ref>[http://www.skincarephysicians.com/skincancernet/who_is_most.html Who is Most at Risk for Melanoma?]</ref> "Intrinsic" factors are generally an individual's family history and inherited [[genotype]], while the most relevant environmental factor is sun exposure.
[[Image:Baltasar-gracian.gif|thumb|100px|[[Baltasar Gracián|Gracián]].]]
Sarbiewski, however, regarded creativity as the exclusive privilege of poetry; creativity was not open to visual artists. "Other arts merely imitate and copy but do not create, because they assume the existence of the material from which they create or of the subject." As late as the end of the [[17th century]], [[André Félibien]] ([[1619]]-[[1675]]) would write that the painter is "so to speak [a] creator." The [[Spain|Spanish]] [[Jesuit]] [[Baltasar Gracián]] ([[1601]]-[[1658]]) wrote similarly as Sarbiewski: "Art is the completion of nature, as it were ''a second Creator''..."<ref>Tatarkiewicz, p. 248.</ref>


By the [[18th century]], the concept of creativity was appearing more often in art theory. It was linked with the concept of [[imagination]], which was on all lips. [[Joseph Addison]] wrote that the imagination "has something in it like creation." [[Voltaire]] declared ([[1740]]) that "the true poet is creative." With both these authors, however, this was rather only a ''comparison'' of poet with creator.<ref>Tatarkiewicz, pp. 248–49.</ref>
[[Epidemiologic]] studies suggest that exposure to [[ultraviolet]] radiation (UVA<ref name="uva">{{cite journal | author = Wang S, Setlow R, Berwick M, Polsky D, Marghoob A, Kopf A, Bart R | title = Ultraviolet A and melanoma: a review | journal = J Am Acad Dermatol | volume = 44 | issue = 5 | pages = 837–46 | year = 2001 | pmid = 11312434 | doi = 10.1067/mjd.2001.114594}}</ref> and UVB) is one of the major contributors to the development of melanoma. UV radiation causes [[DNA damage|damage]] to the [[DNA]] of cells, typically [[thymine]] dimerization, which when unrepaired can create [[mutation]]s in the cell's [[gene]]s. When the cell [[cell division|divides]], these mutations are propagated to new generations of cells. If the mutations occur in [[oncogene]]s or [[tumor suppressor gene]]s, the rate of [[mitosis]] in the mutation-bearing cells can become uncontrolled, leading to the formation of a [[tumor]]. Data from patients suggest that aberrant levels of Activating Transcription Factor in the nucleus of melanoma cells are associated with increased metastatic activity of melanoma cells<ref>Leslie MC, Bar-Eli M.Regulation of gene expression in melanoma: new approaches for treatment.J Cell Biochem. 2005 Jan 1;94(1):25-38.PMID: 15523674 </ref><ref>Bhoumik A, Singha N, O'Connell MJ, Ronai ZA.Regulation of TIP60 by ATF2 modulates ATM activation.J Biol Chem. 2008 Jun 20;283(25):17605-14.</ref><ref>Bhoumik A, Jones N, Ronai Z.Transcriptional switch by activating transcription factor 2-derived peptide sensitizes melanoma cells to apoptosis and inhibits their tumorigenicity.Proc Natl Acad Sci U S A. 2004 Mar 23;101(12):4222-7. </ref>; studies from mice on skin cancer tend to confirm a role for Activating Transcription Factor-2 in cancer progression<ref>Vlahopoulos SA, Logotheti S, Mikas D, Giarika A, Gorgoulis V, Zoumpourlis V.The role of ATF-2 in oncogenesis.Bioessays. 2008 Apr;30(4):314-27.</ref><ref>Huang Y, Minigh J, Miles S, Niles RM.Retinoic acid decreases ATF-2 phosphorylation and sensitizes melanoma cells to taxol-mediated growth inhibition.J Mol Signal. 2008 Feb 12;3:3.PMID: 18269766 </ref>. Occasional extreme sun exposure (resulting in "[[sunburn]]") is causally related to melanoma.<ref>{{cite journal | author = Oliveria S, Saraiya M, Geller A, Heneghan M, Jorgensen C | title = Sun exposure and risk of melanoma | journal = Arch Dis Child | volume = 91 | issue = 2 | pages = 131–8 | year = 2006 | pmid = 16326797 | doi = 10.1136/adc.2005.086918}}</ref> Melanoma is most common on the back in men and on legs in women (areas of intermittent sun exposure). The risk appears to be strongly influenced by socio-economic conditions rather than indoor versus outdoor occupations; it is more common in professional and administrative workers than unskilled workers<ref>{{cite journal | author = Lee J, Strickland D | title = Malignant melanoma: social status and outdoor work | journal = Br J Cancer | volume = 41 | issue = 5 | pages = 757–63 | year = 1980 | pmid = 7426301}}</ref><ref>{{cite journal |author=Pion IA, Rigel DS, Garfinkel L, Silverman MK, Kopf AW |title=Occupation and the risk of malignant melanoma |journal=Cancer |volume=75 |issue=2 Suppl |pages=637–44 |year=1995 |month=January |pmid=7804988 |doi= |url=}}</ref>. Other factors are [[mutation]]s in or total loss of [[tumor suppressor gene]]s. Use of [[sunbed]]s (with deeply penetrating UVA rays) has been linked to the development of skin cancers, including melanoma.
[[Image:Greuze, Portrait of Diderot.jpg|thumb|right|60px|[[Denis Diderot|Diderot]].]]
Other writers took a different view. [[Denis Diderot]] felt that imagination is merely "the memory of forms and contents," and "creates nothing" but only combines, magnifies or diminishes. It was precisely in [[18th century|18th-century]] [[France]], indeed, that the idea of man's creativity met with resistance. [[Charles Batteux]] wrote that "The human mind ''cannot create'', strictly speaking; all its products bear the stigmata of their model; even monsters invented by an imagination unhampered by laws can only be composed of parts taken from nature." [[Luc de Clapiers, marquis de Vauvenargues]] ([[1715]]-[[1747]]), and [[Étienne Bonnot de Condillac]] ([[1715]]-[[1780]]) spoke to a similar effect.<ref>Tatarkiewicz, p. 249.</ref>


Their resistance to the idea of human creativity had a triple source. The expression, "creation," was then reserved for creation ''ex nihilo'' ([[Latin]]: "from nothing"), which was inaccessible to man. Second, creation is a mysterious act, and [[Age of Enlightenment|Enlightenment]] psychology did not admit of mysteries. Third, artists of the age were attached to their rules, and creativity seemed irreconcilable with rules. The latter objection was the weakest, as it was already beginning to be realized (e.g., by [[Houdar de la Motte]], [[1715]]) that rules ultimately are a ''human invention''.<ref>Tatarkiewicz, p. 249.</ref>
Possible significant elements in determining risk include the intensity and duration of sun exposure, the age at which sun exposure occurs, and the degree of [[skin pigmentation]]. Exposure during childhood is a more important risk factor than exposure in adulthood. This is seen in migration studies in [[Australia]]<ref>{{cite journal | author = Khlat M, Vail A, Parkin M, Green A | title = Mortality from melanoma in migrants to Australia: variation by age at arrival and duration of stay | journal = Am J Epidemiol | volume = 135 | issue = 10 | pages = 1103–13 | year = 1992 | pmid = 1632422}}</ref> where people tend to retain the risk profile of their country of birth if they migrate to Australia as an adult. Individuals with blistering or peeling sunburns (especially in the first twenty years of life) have a significantly greater risk for melanoma. This does not mean that sunburn is the cause of melanoma. Instead it is merely statistically correlated. The cause is the exaggerated UV-exposure. It has been shown that [[sunscreen]] - while preventing the sunburn - does not protect from melanoma. <ref name=Wolf1993> {{cite journal |author= Wolf P; Donawho C K; Kripke M L |title= Effect of Sunscreens on UV radiation-induced enhancements of melanoma in mice | journal= J. Nat. Cancer. Inst. |volume=86 |pages=99–105 |year=1994 |doi= 10.1093/jnci/86.2.99 |pmid= 8271307}}</ref>
[[Image:Henri Bergson.jpg|thumb|70px|[[Henri Bergson|Bergson]].]]
Many researchers say that sunscreen can even increase the melanoma risk (see [http://vvv.com/healthnews/dsunscre.html Sunscreens and Cancer by Hans R Larsen]).
In the [[19th century]], art took its compensation for the resistance of preceding centuries against recognizing it as creativity. Now not only was art regarded as creativity, but ''it alone'' was so regarded. When later, at the turn of the [[20th century]], there began to be discussion as well of creativity in the [[science]]s (e.g., [[Jan Łukasiewicz]], [[1878]]-[[1956]]) and in [[nature]] (e.g., [[Henri Bergson]]), this was generally taken as the transference, to the sciences and to nature, of concepts proper to [[art]].<ref>Tatarkiewicz, p. 249.</ref>


The start of the ''scientific'' study of creativity is sometimes taken as [[J. P. Guilford]]'s 1950 address to the [[American Psychological Association]], which helped popularize the subject.
Fair and red-headed people, persons with multiple atypical [[nevi]] or [[dysplastic nevus|dysplastic nevi]] and persons born with giant [[congenital melanocytic nevi]] are at increased risk.<ref name="IMAGE">{{cite journal | author = Bliss J, Ford D, Swerdlow A, Armstrong B, Cristofolini M, Elwood J, Green A, Holly E, Mack T, MacKie R | title = Risk of cutaneous melanoma associated with pigmentation characteristics and freckling: systematic overview of 10 case-control studies. The International Melanoma Analysis Group (IMAGE) | journal = Int J Cancer | volume = 62 | issue = 4 | pages = 367–76 | year = 1995 | pmid = 7635560 | doi = 10.1002/ijc.2910620402}}</ref>


Other students of creativity have taken a more pragmatic approach, teaching practical [[creativity techniques]]. Three of the best-known are [[Alex Osborn]]'s "[[brainstorming]]" (1950s to present), [[Genrikh Altshuller]]'s Theory of Inventive Problem-Solving ([[TRIZ]], 1950s to present), and [[Edward de Bono]]'s "[[lateral thinking]]" (1960s to present).
A family history of melanoma greatly increases a person's risk because mutations in ''[[CDKN2A]]'', ''[[CDK4]]'' and several other genes have been found in melanoma-prone families.<ref>{{cite journal | author = Miller A, Mihm M | title = Melanoma | journal = N Engl J Med | volume = 355 | issue = 1 | pages = 51–65 | year = 2006 | pmid = 16822996 | doi = 10.1056/NEJMra052166}}</ref> Patients with a history of one melanoma are at increased risk of developing a second primary tumour.<ref>{{cite journal | author = Rhodes A, Weinstock M, Fitzpatrick T, Mihm M, Sober A | title = Risk factors for cutaneous melanoma. A practical method of recognizing predisposed individuals | journal = JAMA | volume = 258 | issue = 21 | pages = 3146–54 | year = 1987 | pmid = 3312689 | doi = 10.1001/jama.258.21.3146}}</ref>


==Periods and Personalities==
The incidence of melanoma has increased in the recent years, but it is not clear to what extent changes in behavior, in the environment, or in early detection are involved.<ref>{{cite journal | author = Berwick M, Wiggins C | title = The current epidemiology of cutaneous malignant melanoma | journal = Front Biosci | volume = 11 | issue = | pages = 1244–54 | year = 2006| pmid = 16368510 | doi = 10.2741/1877}}</ref>
=== Ancient Greece ===
*[[Archimedes]]
*[[Plato]]'s [[Ion (dialogue)|Dialogue of Ion]]
; [[3rd century]]
*[[Porphyry of Tyros]] graphically visualised the [[concept]] [[categorie]]s of [[Aristotle]].
; [[4th century]] of the Christian Era
*[[Pappus of Alexandria]] in [[Egypt]] was searching for a science of invention, naming his techniques "[[heuristics]]".


=== 1000s - 1500s ===
To understand how sunscreen can reduce sunburn and at the same time cause melanoma it is necessary to distinguish between [[direct DNA damage]] and [[indirect DNA damage]]. Genetic analysis has shown that 92% of all melanoma are caused by the indirect DNA damage.<ref name=Davies> {{cite journal |author=Davies H.; Bignell G. R.; Cox C.; |year= 2002 |month=6 |title= Mutations of the BRAF gene in human cancer |journal= Nature |volume= 417 |issue= |pages=949–954 |id= |url= http://www.nature.com/nature/journal/v417/n6892/full/nature00766.html |doi=10.1038/nature00766}}</ref>
Although some people believe that dark-skinned people such as African Americans cannot get sunburns, they are in fact susceptible, and should use sunscreen accordingly. The recommended amount of sunscreen for adults is 1 oz, which is enough to fill a shot glass.


; [[1200s]]
==Genetics==
About [[1275]], in an early attempt to use [[logic]]al means to produce [[knowledge]], [[Ramon Llull]] designed a method of combining attributes selected from a number of lists, which he first published in full in his ''Ars generalis ultima'' or ''Ars magna'' ([[1305]]). This used concept structures of the [[mind map|mind-map]] form.
Familial melanoma is genetically heterogeneous,<ref>{{cite journal | author = Greene MH. | title = The genetics of hereditary melanoma and nevi | journal = Cancer | volume = 86 | issue = 11 | pages = 2464–2477 | year = 1998 | pmid = 10630172 | doi = 10.1002/(SICI)1097-0142(19991201)86:11 <2464::AID-CNCR3>3.0.CO;2-F | doi_brokendate = 2008-06-21}}</ref> and loci for familial melanoma have been identified on the chromosome arms 1p, 9p and 12q. Multiple genetic events have been related to the pathogenesis of melanoma.<ref>{{cite journal | author = Halachmi S, Gilchrest BA. | title = Update on genetic events in the pathogenesis of melanoma | journal = Curr Opin Oncol | volume = 13 | issue = 2 | pages = 129–136 | year = 2001 | pmid = 11224711 | doi = 10.1097/00001622-200103000-00008}}</ref> The multiple [[Tumor suppressor gene|tumor suppressor]] 1 (CDKN2A/MTS1) gene encodes p16INK4a - a low-molecular weight protein inhibitor of [[cyclin-dependent kinase|cyclin-dependent protein kinases]] (CDKs) - which has been localised to the p21 region of [[Chromosome 9 (human)|human chromosome 9]].<ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=gene&cmd=Retrieve&dopt=full_report&list_uids=1029 CDKN2A cyclin-dependent kinase inhibitor 2A (melanoma, p16, inhibits CDK4)] from Entrez Gene</ref>
Today, melanomas are diagnosed only after they become visible on the skin. In the future, however, physicians will hopefully be able detect melanomas based on a patient’s [[genotype]], not just his or her [[phenotype]]. Recent genetic advances promise to help doctors to identify people with high-risk genotypes and to determine which of a person’s lesions have the greatest chance of becoming cancerous.
A number of rare mutations, which often run in families, are known to greatly increase one’s susceptibility to melanoma. One class of mutations affects the gene [[CDKN2A]]. An alternative [[reading frame]] mutation in this gene leads to the destabilization of [[p53]], a [[transcription factor]] involved in [[apoptosis]] and in fifty percent of human cancers. Another mutation in the same gene results in a non-functional inhibitor of [[CDK4]], a [cyclin-dependent kinase] that promotes cell division. Mutations that cause the skin condition [[Xeroderma Pigmentosum]] (XP) also seriously predispose one to melanoma. Scattered throughout the genome, these mutations reduce a cell’s ability to repair DNA. Both CDKN2A and XP mutations are highly penetrant.
Other mutations confer lower risk but are more prevalent in the population. People with mutations in the MC1R gene, for example, are two to four times more likely to develop melanoma than those with two wild-type copies of the gene. [[Melanocortin 1 receptor|MC1R]] mutations are very common; in fact, all people with red hair have a mutated copy of the gene.
Two-gene models of melanoma risk have already been created, and in the future, researchers hope to create genome-scale models that will allow them to predict a patient’s risk of developing melanoma based on his or her genotype.
In addition to identifying high-risk patients, researchers also want to identify high-risk lesions within a given patient. Many new technologies, such as [[optical coherence tomography]] (OCT), are being developed to accomplish this. OCT allows pathologists to view 3-D reconstructions of the skin and offers more resolution than past techniques could provide. In vivo [[confocal microscopy]] and fluorescently tagged [[antibodies]] are also proving to be valuable diagnostic tools.


;[[1470s]]
==Detection and prevention==
*[[Leonardo da Vinci]]


=== 1500s - 2000s ===
Minimizing exposure to sources of ultraviolet radiation (the sun and sunbeds),<ref>{{cite journal | author = Autier P | title = Cutaneous malignant melanoma: facts about sunbeds and sunscreen | journal = Expert Rev Anticancer Ther | volume = 5 | issue = 5 | pages = 821–33 | year = 2005 | pmid = 16221052 | doi = 10.1586/14737140.5.5.821}}</ref> following sun protection measures and wearing [[sun protective clothing]] (long-sleeved shirts, long trousers, and broad-brimmed hats) can offer protection. In the past it was recommended to use [[sunscreen]]s with an [[sunscreen|SPF]] rating of 30 or higher on exposed areas.<ref>[http://www.cancer.org/docroot/cri/content/cri_2_4_2x_can_melanoma_be_prevented_50.asp Can Melanoma Be Prevented?]</ref> However, there are severe doubts about the ability of [[sunscreen]] to prevent melanoma.<ref>{{cite journal |author=Garland C, Garland F, Gorham E |title=Could sunscreens increase melanoma risk? |url= http://www.ajph.org/cgi/reprint/82/4/614| journal=Am J Public Health |volume=82 |issue=4 |pages=614–5 |year=1992 |pmid=1546792 |issn=}}</ref>


There was no real demand for such a science until the [[19th century]], when the [[Industrial Revolution]] started:
[[Image:WB032021.JPG|thumb|230px|A melanoma showing irregular borders and colour, diameter over 10&nbsp;mm and asymmetry (ie A, B, C and D.)]]
* [[William Gordon]] - [[Synectics]]
To prevent or detect melanomas (and increase survival rates), it is recommended to learn what they look like (see "ABCDE" mnemonic below), to be aware of [[Melanocytic nevus|moles]] and check for changes (shape, size, color, itching or bleeding) and to show any suspicious moles to a doctor with an interest and skills in skin malignancy.<ref>{{cite journal | author = Friedman R, Rigel D, Kopf A | title = Early detection of malignant melanoma: the role of physician examination and self-examination of the skin | journal = CA Cancer J Clin | volume = 35 | issue = 3 | pages = 130–51 | year = 1985| pmid = 3921200 | doi = 10.3322/canjclin.35.3.130}}</ref>
* [[Edward Matchett]] - [[Fundamental design method]] (1968)
* Idan Gafni - Association expansion cards ([[Object Pairing]])
* [[Edward de Bono]] - Complex of techniques ...
* [[L. D. Miles]] - [[Value engineering]] - a technique for operating with available knowledge


Following along Miles’ line of thought were:
A popular method for remembering the signs and symptoms of melanoma is the mnemonic "ABCDE":
* [[Fritz Zwicky]] - [[Morphological Analysis]]
* '''A'''symmetrical skin lesion.
* [[Yoji Akoa]] - Quality Function Deployment
* '''B'''order of the lesion is irregular.
* '''C'''olor: melanomas usually have multiple colors.
* '''D'''iameter: moles greater than 6&nbsp;mm are more likely to be melanomas than smaller moles.
* '''E'''volution: The evolution (ie change) of a mole or lesion may be a hint that the lesion is becoming malignant --or-- '''E'''levation: The mole is raised or elevated above the skin.


* beginning in the mid-[[1940s]] - start of ''knowledge-based'' creativty era by [[TRIZ]]
The '''E''' is sometimes omitted, as in the [[ABCD guideline]].


; Early [[20th century]]
People with a personal or family history of skin cancer or of [[dysplastic nevus syndrome]] (multiple atypical moles) should see a dermatologist at least once a year to be sure they are not developing melanoma.
*[[Pablo Picasso]] painter
*[[Marcel Duchamp]] artist
;[[1940s]]
*[[Fritz Zwicky]] - [[Morphological Analysis]]
*[[Lawrence Delos Miles]] - [[Value engineering]] - technique for operating with available knowledge, Methods of collecting and organizing knowledge about a problem and the system. [[Functional analysis]]. Morphological approach.
*[[George Polya]]
;[[1950s]]
*[[Alex Osborn]] - Methods of reducing [[psychological inertia]]. [[Team work]].
*[[Sid Parnes]]
*[[Genrich Altshuller|Genrikh Altshuller]] - [[TRIZ]], [[ARIZ]]
;[[1960s]]
*[[Carl Jung]] classified creativity as one of the five main instinctive forces in humans (Jung 1964)
*[[Edward Matchett]] - [[Fundamental design method]] (1968)
* [[Carl Rogers]]' essay, "Towards a Theory of Creativity" (1961):
*[[William Gordon]] - [[Synectics]]
*[[Edward de Bono]] - [[Lateral thinking]]
*[[J. P. Guilford]] - measuring creativity
;[[1970s]]
*[[Albert Rothenberg]] coined the term '[[Janusian thinking]]'
*[[Yoji Akao]] - [[Quality function deployment]]
*[[Total creativity]] - the ultimate goal in the philosophy of [[John David Garcia]]
*[[Carlos Castaneda]] - A Separate Reality: Further Conversations with Don Juan
*[[Joseph D. Novak]] [http://wwwcsi.unian.it/educa/curriculum/vita_jdn.html] [http://www.ihmc.us/users/user.php?UserID=jnovak] at [[Cornell University]] - [[Concept map]]
*[[Ellis Paul Torrance]] - Torrance Tests of Creative Thinking
;[[1980s]]
*[[Paul Palnik]]- [[Creative Consciousness]] The healthiest state of mind. [1981]


;[[1990s]]
==Diagnosis==
*[[Tony Buzan]] - [[mind map]]
Moles that are irregular in color or shape are suspicious of a malignant or a premalignant melanoma. Following a visual examination and a [[Dermatoscopy|dermatoscopic exam]] (an instrument that illuminates a mole, revealing its underlying pigment and vascular network structure), or an examination using other ''in vivo'' diagnostic tools, such as a confocal microscope, the doctor may biopsy the suspicious mole. If it is malignant, the mole and an area around it needs excision.
*[[Idan Gafni]] - association expansion cards concept ([[Object Pairing]])
;[[2000s]]
*[http://www.crea.server.de/ Creative capabilities and the promotion of highly innovative research] - organizational factors fostering creativity in science


=== Undated ===
The diagnosis of melanoma requires experience, as early stages may look identical to harmless [[Mole (skin marking)|moles]] or not have any color at all. A [[biopsy]] performed under [[local anesthesia]] is often required to assist in making or confirming the [[diagnosis]] and in defining the severity of the melanoma.


* [[Reviewed Dendrogram]] technique, relies on the experience of designers which may be limited to certain areas of expertise such as chemistry or electronics. Thus, a solution that might be simpler and cheaper using magnetism could be missed.
''Excisional biopsy'' is the management of choice; this is where the suspect lesion is totally removed with an adequate ellipse of surrounding skin and tissue.<ref>{{cite journal | author = Swanson N, Lee K, Gorman A, Lee H | title = Biopsy techniques. Diagnosis of melanoma | journal = Dermatol Clin | volume = 20 | issue = 4 | pages = 677–80 | year = 2002 | pmid = 12380054 | doi = 10.1016/S0733-8635(02)00025-6}}</ref> The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin, enabling the [[pathology|histopathologist]] to determine the depth of penetration of the melanoma by microscopic examination. This is described by [[Clark's level]] (involvement of skin structures) and [[Breslow's depth]] (measured in millimeters).


==Notes==
[[Image:Malignant melanoma (1) at thigh Case 01.jpg|100px|Malignant melanoma in skin biopsy with [[Hematoxylin|H]] and [[eosin|E]] stain.]]
<div class="references-small" style="-moz-column-count:2; column-count:2;">
[[Image:Malignant melanoma (2) at thigh Case 01.jpg|100px|This case may represent superficial spreading melanoma.]]
<references />
[[Image:Malignant melanoma (3) at thigh Case 01.jpg|100px|The same case as the last one.]]
</div>
[[Image:Malignant melanoma (4) at thigh Case 01.jpg|100px|Enlargement of the image.]]


== References ==
If an excisional biopsy is not possible in certain larger pigmented lesions, a ''punch biopsy'' may be performed using a surgical punch (an instrument similar to a tiny cookie cutter with a handle, with an opening ranging in size from 1 to 6&nbsp;mm). The punch is used to remove a plug of skin (down to the subcutaneous layer) from a portion of a large suspicious lesion, for histopathological examination.
* {{cite book | author=Tatarkiewicz, Władysław | authorlink=Władysław Tatarkiewicz | title=A History of Six Ideas: an Essay in Aesthetics | location=Translated from the Polish by [[Christopher Kasparek]], The Hague | publisher=Martinus Nijhoff | year=1980}} (Traces the history of key [[aesthetics]] [[concept]]s, including [[art]], [[beauty]], [[form]], creativity, [[mimesis]], and the aesthetic experience.)
* {{cite book | author=Sternberg, R.J. | coauthors=Lubart, T.I. | chapter=The Concept of Creativity: Prospects and Paradigms | editor=ed. Sternberg, R.J. | title=Handbook of Creativity | year=1999 | publisher=Cambridge University Press | authorlink=Robert Sternberg}}
* {{cite book | author=Albert, R.S. | coauthors=Runce, M.A. | chapter=A History of Research on Creativity | editor=ed. Sternberg, R.J. | title=Handbook of Creativity | year=1999 | publisher=Cambridge University Press}}


[[Category:Creativity]]
[[Lactate dehydrogenase]] (LDH) tests are often used to screen for [[metastasis|metastases]], although many patients with metastases (even end-stage) have a normal LDH; extraordinarily high LDH often indicates metastatic spread of the disease to the liver. It is common for patients diagnosed with melanoma to have chest X-rays and an LDH test, and in some cases [[computed tomography|CT]], [[MRI]], [[Positron emission tomography|PET]] and/or PET/CT scans. Although controversial, sentinel [[lymph node]] biopsies and examination of the lymph nodes are also performed in patients to assess spread to the lymph nodes.
[[Category:History by topic|Creativity]]

Sometimes the skin lesion may bleed, itch, or ulcerate, although this is a very late sign. A slow-healing lesion should be watched closely, as that may be a sign of melanoma. Be aware also that in circumstances that are still poorly understood, melanomas may "regress" or spontaneously become smaller or invisible - however the malignancy is still present. '''Amelanotic''' (colorless or flesh-colored) melanomas do not have pigment and may not even be visible. '''[[Lentigo]] maligna''', a superficial melanoma confined to the topmost layers of the skin (found primarily in older patients) is often described as a "stain" on the skin. Some patients with metastatic melanoma do not have an obvious detectable primary tumor.

==Types of primary melanoma==
The most common types of Melanoma in the skin:
* [[superficial spreading melanoma]] (SSM)
* [[nodular melanoma]]
* [[acral lentiginous melanoma]]
* [[lentigo maligna melanoma|lentigo maligna (melanoma)]]
Any of the above types may produce melanin (and be dark in colour) or not (and be amelanotic - not dark). Similarly any subtype may show desmoplasia (dense fibrous reaction with neurotropism) which is a marker of aggressive behaviour and a tendency to local recurrence.

Elsewhere:
* [[clear cell tumor|clear cell sarcoma]] (Melanoma of Soft Parts)
* [[mucosal melanoma]]
* [[uveal melanoma]]

==Prognostic factors==
{{see also|Breslow's depth}}
Features that affect [[prognosis]] are [[tumor]] thickness in millimeters ([[Breslow's depth]]), depth related to skin structures ([[Clark level]]), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating [[lymphocyte]]s (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant [[metastasis]].<ref>{{cite journal | author = Homsi J, Kashani-Sabet M, Messina J, Daud A | title = Cutaneous melanoma: prognostic factors | journal = Cancer Control | volume = 12 | issue = 4 | pages = 223–9 | year = 2005 | pmid = 16258493}}''[https://www.moffitt.usf.edu/pubs/ccj/v12n4/pdf/223.pdf Full text (PDF)]''</ref>

Certain types of melanoma have worse prognoses but this is explained by their [[Breslow's depth|thickness]]. Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. Local recurrences tend to behave similarly to a primary unless they are at the site of a [[wide local excision]] (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion.

When melanomas have spread to the [[lymph node]]s, one of the most important factors is the number of nodes with malignancy. Extent of malignancy within a node is also important; micrometastases in which malignancy is only microscopic have a more favorable prognosis than macrometastases. In some cases micrometastases may only be detected by special staining, and if malignancy is only detectable by a rarely-employed test known as the [[polymerase chain reaction]] (PCR), the prognosis is better. Macrometastases in which malignancy is clinically apparent (in some cases cancer completely replaces a node) have a far worse prognosis, and if nodes are matted or if there is extracapsular extension, the prognosis is still worse.

When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.<ref name=AJCC>{{cite journal | author = Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J | title = Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma | journal = J Clin Oncol | volume = 19 | issue = 16 | pages = 3635–48 | year = 2001 | pmid = 11504745}}''[http://www.jco.org/cgi/content/full/19/16/3635 Full text]''</ref> The median survival is 6 to 12 months. Treatment is [[Palliative care|palliative]], focusing on life-extension and [[quality of life]]. In some cases, patients may live many months or even years with metastatic melanoma (depending on the aggressiveness of the treatment). Metastases to skin and lungs have a better prognosis. Metastases to brain, bone and liver are associated with a worse prognosis.

There is not enough definitive evidence to adequately stage, and thus give a prognosis for ocular melanoma and melanoma of soft parts, or mucosal melanoma (e.g. rectal melanoma), although these tend to metastasize more easily. Even though regression may increase survival, when a melanoma has regressed, it is impossible to know its original size and thus the original tumor is often worse than a [[Pathology|pathology report]] might indicate.

==Staging==

''Further context on [[cancer staging]] is available at [[TNM]].''

Also of importance are the "Clark level" and "Breslow depth" which refer to the microscopic depth of tumor invasion.<ref> [http://chorus.rad.mcw.edu/doc/00955.html Malignant melanoma: staging] at Collaborative Hypertext of Radiology</ref>

Melanoma stages:<ref name=AJCC />

'''Stage 0''': Melanoma in Situ (Clark Level I), 100% Survival

'''Stage I/II''': Invasive Melanoma, 85-95% Survival
*T1a: Less than 1.00&nbsp;mm primary, w/o Ulceration, Clark Level II-III
*T1b: Less than 1.00&nbsp;mm primary, w/Ulceration or Clark Level IV-V
*T2a: 1.00-2.00&nbsp;mm primary, w/o Ulceration

'''Stage II''': High Risk Melanoma, 40-85% Survival
*T2b: 1.00-2.00&nbsp;mm primary, w/ Ulceration
*T3a: 2.00-4.00&nbsp;mm primary, w/o Ulceration
*T3b: 2.00-4.00&nbsp;mm primary, w/ Ulceration
*T4a: 4.00&nbsp;mm or greater primary w/o Ulceration
*T4b: 4.00&nbsp;mm or greater primary w/ Ulceration

'''Stage III''': Regional Metastasis, 25-60% Survival
*N1: Single Positive Lymph Node
*N2: 2-3 Positive Lymph Nodes OR Regional Skin/In-Transit Metastasis
*N3: 4 Positive Lymph Nodes OR Lymph Node and Regional Skin/In Transit Metastases

'''Stage IV''': Distant Metastasis, 9-15% Survival
*M1a: Distant Skin Metastasis, Normal [[Lactate dehydrogenase|LDH]]
*M1b: Lung Metastasis, Normal [[Lactate dehydrogenase|LDH]]
*M1c: Other Distant Metastasis OR Any Distant Metastasis with Elevated [[Lactate dehydrogenase|LDH]]

''Based Upon AJCC 5-Year Survival With Proper Treatment''

==Treatment==
Surgery is the first choice therapy for localized cutaneous melanoma. Depending on the stage a [[sentinel lymph node]] biopsy is done as well, although [http://www.malignant-melanoma.org/sentinel-node-biopsy/sentinel-node-biopsy-false-positivity/ controversy exists around trial evidence] for this procedure. Treatment of advanced malignant melanoma is performed from a multidisciplinary approach.

===Surgery===

Diagnostic punch or excisional biopsies may appear to excise (and in some cases may indeed actually remove) the tumor, but further surgery is often necessary to reduce the risk of recurrence.

Complete surgical excision with adequate margins and assessment for the presence of detectable metastatic disease along with short- and long-term followup is standard. Often this is done by a "wide local excision" (WLE) with 1 to 2&nbsp;cm margins. The wide excision aims to reduce the rate of tumour recurrence at the site of the original lesion. This is a common pattern of treatment failure in melanoma. Considerable research has aimed to elucidate appropriate margins for excision with a general trend toward less aggressive treatment during the last decades.<ref>{{cite journal | author = Balch C, Urist M, Karakousis C, Smith T, Temple W, Drzewiecki K, Jewell W, Bartolucci A, Mihm M, Barnhill R | title = Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial | journal = Ann Surg | volume = 218 | issue = 3 | pages = 262–7; discussion 267–9 | year = 1993 | pmid = 8373269 | doi = 10.1097/00000658-199309000-00005}}</ref>
Melanomas which spread usually do so to the [[lymph nodes]] in the region of the tumor before spreading elsewhere. Attempts to improve survival by removing lymph nodes surgically ([[lymphadenectomy]]) were associated with many complications but unfortunately no overall survival benefit. Recently the technique of [[sentinel lymph node]] biopsy has been developed to reduce the complications of lymph node surgery while allowing assessment of the involvement of nodes with tumor.[http://www.malignant-melanoma.org/surgery/lymph-node-dissection-surgery/]

Although controversial and without prolonging survival, "sentinel lymph node" biopsy is often performed, especially for T1b/T2+ tumors, mucosal tumors, ocular melanoma and tumors of the limbs. A process called [[lymphoscintigraphy]] is performed in which a radioactive tracer is injected at the tumor site in order to localize the "sentinel node(s)". Further precision is provided using a blue tracer [[dye]] and surgery is performed to biopsy the node(s). Routine H&E staining, and [[immunoperoxidase]] staining will be adequate to rule out node involvement. [[polymerase chain reaction|PCR]] tests on nodes, usually performed to test for entry into clinical trials, now demonstrate that many patients with a negative SLN actually had a small number of positive cells in their nodes. Alternatively, a fine-needle aspiration may be performed and is often used to test masses.

If a lymph node is positive, depending on the extent of lymph node spread, a radical lymph node dissection will often be performed. If the disease is completely resected, the patient will be considered for adjuvant therapy.

===Adjuvant treatment===
High risk melanomas may require adjuvant treatment. In the United States most patients in otherwise good health will begin up to a year of high-dose [[interferon]] treatment, which has severe side effects but may improve the patient's prognosis.<ref>{{cite journal | author = Kirkwood J, Strawderman M, Ernstoff M, Smith T, Borden E, Blum R | title = Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684 | journal = J Clin Oncol | volume = 14 | issue = 1 | pages = 7–17 | year = 1996 | pmid = 8558223}}</ref> This claim is not supported by all research at this time, and in Europe interferon is usually not used outside the scope of clinical trials.<ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Richards J, Flaherty L, Ernstoff M, Smith T, Rao U, Steele M, Blum R | title = High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190 | journal = J Clin Oncol | volume = 18 | issue = 12 | pages = 2444–58 | year = 2000 | pmid = 10856105}}</ref><ref>{{cite journal | author = Kirkwood J, Ibrahim J, Sondak V, Ernstoff M, Ross M | title = Interferon alfa-2a for melanoma metastases | journal = Lancet | volume = 359 | issue = 9310 | pages = 978–9 | year = 2002 | pmid = 11918944 | doi = 10.1016/S0140-6736(02)08001-7}}</ref>

Metastatic melanomas can be detected by X-rays, CT scans, MRIs, PET and PET/CTs, ultrasound, LDH testing and photoacoustic detection.<ref>{{cite journal | author = Weight RM, Viator JA, Dale PS, Caldwell CW, Lisle AE. | title = Photoacoustic detection of metastatic melanoma cells in the human circulatory system | journal = Opt Lett.| volume = 31 | issue = 20 | pages = 2998–3000 | year = 2006 | pmid = 17001379 | doi = 10.1364/OL.31.002998}}</ref>

====Chemotherapy and immunotherapy====
Various [[chemotherapy]] agents are used, including [[dacarbazine]] (also termed DTIC), [[Cancer immunotherapy|immunotherapy]] (with [[interleukin-2]] (IL-2) or [[interferon]] (IFN)) as well as local perfusion are used by different centers. They can occasionally show dramatic success, but the overall success in metastatic melanoma is quite limited.<ref>{{cite journal | author = Bajetta E, Del Vecchio M, Bernard-Marty C, Vitali M, Buzzoni R, Rixe O, Nova P, Aglione S, Taillibert S, Khayat D | title = Metastatic melanoma: chemotherapy | journal = Semin Oncol | volume = 29 | issue = 5 | pages = 427–45 | year = 2002 | pmid = 12407508 | doi = 10.1053/sonc.2002.35238}}</ref> IL-2 (Proleukin) is the first new therapy approved for the treatment of metastatic melanoma in 20 years. Studies have demonstrated that IL-2 offers the possibility of a complete and long-lasting remission in this disease, although only in a small percentage of patients.<ref>{{cite journal | author = Buzaid A | title = Management of metastatic cutaneous melanoma | journal = Oncology (Williston Park) | volume = 18 | issue = 11 | pages = 1443–50; discussion 1457–9 | year = 2004 | pmid = 15609471}}</ref> A number of new agents and novel approaches are under evaluation and show
promise.<ref>{{cite journal | author = Danson S, Lorigan P | title = Improving outcomes in advanced malignant melanoma: update on systemic therapy | journal = Drugs | volume = 65 | issue = 6 | pages = 733–43 | year = 2005 | pmid = 15819587 | doi = 10.2165/00003495-200565060-00002}}</ref>

On June 23, 2008, Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem [http://www.israelnationalnews.com/News/Flash.aspx/148679 announced] they developed a vaccine that prevents recurrences of the disease among previous sufferers and increases chances of survival for current ones.

===Lentigo maligna treatment===
Some superficial melanomas (lentigo maligna) have resolved with an experimental treatment, [[imiquimod]] (Aldara) topical cream, an immune enhancing agent. Application of this cream has been shown to decrease tumor size prior to surgery, reducing the invasiveness of the procedure. This treatment is used especially for smaller melanoma in situ lesions located in cosmetically sensitive regions. Several published studies demonstrate a 70% cure rate with this topical treatment. With lentigo maligna, surgical cure rates are no higher. Some dermasurgeons are combining the 2 methods: surgically excising the cancer and then treating the area with Aldara cream postoperatively for three months.

===Radiation and other therapies===
[[Radiation therapy]] is often used after surgical resection for patients with locally or regionally advanced melanoma or for patients with unresectable distant metastases. It may reduce the rate of local recurrence but does not prolong survival.<ref>{{cite journal | author = Bastiaannet E, Beukema J, Hoekstra H | title = Radiation therapy following lymph node dissection in melanoma patients: treatment, outcome and complications | journal = Cancer Treat Rev | volume = 31 | issue = 1 | pages = 18–26 | year = 2005 | pmid = 15707701 | doi = 10.1016/j.ctrv.2004.09.005}}</ref>

In research setting other therapies, such as [[gene therapy]], may be tested.<ref>{{cite journal | author = Sotomayor M, Yu H, Antonia S, Sotomayor E, Pardoll D | title = Advances in gene therapy for malignant melanoma | journal = Cancer Control | volume = 9 | issue = 1 | pages = 39–48 | year = | pmid = 11907465}}''[https://www.moffitt.usf.edu/pubs/ccj/v9n1/pdf/39.pdf Full text (PDF)]''</ref> [[Radioimmunotherapy]] of metastatic melanoma is currently under investigation.
Experimental treatment developed at the National Cancer Institute (NCI), part of the National Institutes of Health in the US was used in advanced (metastatic) melanoma with moderate success.
The treatment, adoptive transfer of genetically altered autologous lymphocytes,
depends on delivering genes that encode so called T cell receptors (TCRs), into patient's lymphocytes. After that manipulation lymphocytes recognize and bind to certain molecules found on the surface of melanoma cells and kill them.<ref name="nih">[http://www.nih.gov/news/pr/aug2006/nci-31b.htm Press release from the NIH]</ref>

==Complications==
People with melanoma may not feel like eating, especially if they are uncomfortable or tired. Foods may taste different than they did previously. Poor appetite, nausea, or vomiting are all side-effects of melanoma. Good nutrition however often helps people with cancer feel better and have more energy.<ref>{{cite web |url=http://www.nci.nih.gov/cancertopics/wyntk/melanoma/page28 |title=What You Need To Know About™ Melanoma - Nutrition |accessdate=2008-05-18 |publisher=[[National Cancer Institute]]}}</ref>

==Future thought==
One important pathway in [[melanin]] synthesis involves the transcription factor [[MITF]]. The [[MITF gene]] is highly conserved and is found in people, mice, birds, and even fish. MITF production is regulated via a fairly straightforward pathway. [[UV radiation]] causes increased expression of transcription factor [[p53]] in [[keratinocytes]], and p53 causes these cells to produce melanocyte stimulating hormone ([[MSH]]), which binds to [[melanocortin 1 receptor]]s (MC1R) on [[melanocytes]]. Ligand-binding at MC1R receptors activates [[adenyl cyclases]], which produce [[cAMP]], which activates [[CREB]], which promotes [[MITF]] expression. The targets of MITF include [[p16]] (a [[CDK inhibitor]]) and [[Bcl2]], a gene essential to [[melanocyte]] survival. It is often difficult to design drugs that interfere with transcription factors, but perhaps new drugs will be discovered that can impede some reaction in the pathway upstream of MITF.
Studies of [[chromatin]] structure also promise to shed light on transcriptional regulation in melanoma cells. It has long been assumed that [[nucleosomes]] are positioned randomly on [[DNA]], but [[murine]] studies of genes involved in melanin production now suggest that nucleosomes are stereotypically positioned on DNA. When a gene is undergoing transcription, its transcription start site is almost always nucleosome-free. When the gene is silent, however, nucleosomes often block the transcriptional start site, suggesting that nucleosome position may play a role in gene regulation.
Finally, given the fact that tanning helps protect skin cells from UV-induced damage, new melanoma prevention strategies could involve attempts to induce tanning in individuals who would otherwise get sunburns. Redheads, for example, do not tan because they have MC1R mutations. In mice, it has been shown that the melanin production pathway can be rescued downstream of MC1R. Perhaps such a strategy will eventually be used to protect humans from melanoma.

==References==
{{Reflist|2}}

==External links==
{{commonscat|Melanoma}}
{{linkfarm}}

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;Advocate organizations
* [http://www.melanomainternational.org/ Melanoma International Foundation]
* [http://www.melanoma.org/ Melanoma Research Foundation]
* [http://www.skincheck.org/ Melanoma Education Foundation]
* [http://www.the-bulls.co.uk/index.html The Dr. Lucy M. Bull Lectureship and Research Fund]
* [http://www.melanoma.com/ melanoma.com] (commercially supported site)
* [http://www.eyemole.com/ eyeMole.com] (Useful information and media regarding Melanoma - commercially supported site)


;Forums for patients, families, and survivors
* [http://www.melanomaforum.org/ Melanoma International Foundation]
* [http://www.mpip.org/ Melanoma Research Foundation]

;Medical information
*[http://www.israelnationalnews.com/News/Flash.aspx/148679 Israeli scientists develop Vaccine against Melanoma]
*[http://www.melanomaperspectives.com Melanoma Perspectives]
*[http://www.skincancer.org/melanoma/index.php Information on Melanoma from The Skin Cancer Foundation]
* [http://www.cimit.org/ CIMIT Center for Integration of Medicine and Innovative Technology - New Advances and Research in Melanoma]
* [http://www.newsmonster.co.uk/sunlight-prevents-and-cures-cancer-and-a-healthy-tan-makes-you-look-good.html Sunbathing helps prevent cancer: UK newspaper article]
* [http://www.dermnetnz.org/lesions/melanoma.html DermNet NZ: Melanoma]
* [http://www.startoncology.net/capitoli/interno_capitoli/default.jsp?menu=professional&ID=32&language=eng Professional melanoma information]
* [http://www.rah.sa.gov.au/cancer/melanoma/ Adelaide Melanoma Unit] (free information on diagnosis, prevention, treatment of melanoma; booklet available at cost)
* [http://copublications.greenfacts.org/en/sunbeds/index.htm Assessing health risks of sunbeds and UV exposure] summary by [[GreenFacts]] of the European Commission SCCP assessment
* [http://www.theschlip.com/ James A. Schlipmann Melanoma Cancer Foundation]

;Patient information
* [http://www.melanomaintl.org/ MIF Patient & Family Toll-Free Helpline: 1-866-463-6663]
* [http://www.cancer.gov/pdf/WYNTK/WYNTK_moles.pdf What You Need To Know About Moles and Dysplastic Nevi] - patient information booklet from cancer.gov (PDF)
* [http://www.mpip.org/ MPIP: Melanoma patients information page]
* [http://www.MelanomaSupport.org.au/ Melanoma Support Organisation (Victoria, Australia)] - Ran by Melanoma Survivors with strong links to Cancer Institutes in Victoria, Australia
* [http://www.melanomapatients.org/ Melanoma Patients Australia]
* [http://www.tustison.com/interests1.shtml/ Mikes Page - The Melanoma Resource Center]
* [http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=mel-l&A=1/ MEL-L - Melanoma e-mail list for patients, caregivers and healthcare professionals] - Supporting the Melanoma Patient since 1996
* [http://www.malignant-melanoma.org Malignant-Melanoma.org] - An evidence based site explaining trial results to patients in simplified language

;Images and photographs
*[http://www.dermnet.com/thumbnailIndex.cfm?moduleID=14&moduleGroupID=427&groupIndex=0&numcols=0 Melanoma photo library at Dermnet]
* [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=53 DermAtlas: Melanoma images]
* [http://www.lumen.luc.edu/lumen/MedEd/medicine/dermatology/melton/melcont.htm Photographs of melanoma]
* [http://melanoma.blogsome.com/ Skin imaging methods for melanoma diagnosis](commercial advertising)
* [http://dermatologie.free.fr/cas21b.htm Pictures of melanomas]
* [http://dermatologie.free.fr/cas183re.htm Pictures of amelanotic melanomas]

;Videos
* [http://revver.com/video/700464/melanoma/ MELANOMA]
* [http://www.healthination.com/skin_cancer.php Health Video: Melanoma and Non-Melanoma Skin Cancers - Overview, Prevention, and Treatment]
* [http://www.healthination.com/skin_self_exam.php Health Video: How to Perform a Skin Self Exam]

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[[be-x-old:Мэлянома]]
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Revision as of 03:10, 10 October 2008

This article is about the History of creativity. For the main article, see Creativity.

The ways in which societies have perceived the concept of creativity have changed throughout history, as has the term itself. The ancient Greek concept of art (in Greek, "techne" — the root of "technique" and "technology"), except for poetry, involved not freedom of action but subjection to rules. In Rome, the Greek concept was partly shaken, and visual artists were viewed as sharing, with poets, imagination and inspiration.

Under medieval Christianity, the Latin "creatio" came to designate God's act of "creatio ex nihilo" ("creation from nothing"); thus "creatio" ceased to apply to human activities. The Middle Ages, however, went even further than antiquity, when they revoked poetry's exceptional status: it, too, was an art and therefore craft and not creativity.

Renaissance men sought to give voice to their sense of their freedom and creativity. The first to apply the word, "creativity," however, was the 17th-century Polish poet, Maciej Kazimierz Sarbiewski — but he applied it only to poetry. For over a century and a half, the idea of human creativity met with resistance, due to the expression "creation" being reserved for creation "from nothing."

In the 19th century, art took its revenge: now not only was it recognized as creativity, but it alone was. When later, at the turn of the 20th century, there began to be discussion as well of creativity in the sciences and in nature, this was taken as the transference, to the sciences and to nature, of concepts proper to art.

Term and concept

Plato.

The ancient Greeks had no terms corresponding to "to create" or "creator." The expression "poiein" ("to make") sufficed. And even that was not extended to art in general, but only to poiesis (poetry) and to the poietes (poet, or "maker") who made it. Plato asks in The Republic, "Will we say, of a painter, that he makes something?" and answers, "Certainly not, he merely imitates." To the ancient Greeks, the concept of a creator and of creativity implied freedom of action, whereas the Greeks' concept of art involved subjection to laws and rules. Art (in Greek, "techne") was "the making of things, according to rules." It contained no creativity, and it would have been — in the Greeks' view — a bad state of affairs if it had.[1]

This understanding of art had a distinct premise: Nature is perfect and is subject to laws, therefore man ought to discover its laws and submit to them, and not seek freedom, which will deflect him from that optimum which he can attain. The artist was a discoverer, not an inventor.[2]

The sole exception to this Greek view — a great exception — was poetry. The poet made new things — brought to life a new world — while the artist merely imitated. And the poet, unlike the artist, was not bound by laws. There were no terms corresponding to "creativity" or "creator," but in reality the poet was understood to be one who creates. And only he was so understood. In music, there was no freedom: melodies were prescribed, particularly for ceremonies and entertainments, and were known tellingly as "nomoi" ("laws"). In the visual arts, freedom was limited by the proportions that Polyclitus had established for the human frame, and which he called "the canon" (meaning, "measure"). Plato argued in Timaeus that, to execute a good work, one must contemplate an eternal model. Later the Roman, Cicero, would write that art embraces those things "of which we have knowledge" ("quae sciuntur").[3]

Horace.

Poets saw things differently. Book I of the Odyssey asks, "Why forbid the singer to please us with singing as he himself will?" Aristotle had doubts as to whether poetry was imitation of reality, and as to whether it required adherence to truth: it was, rather, the realm of that "which is neither true nor false."[4]

In Rome, these Greek concepts were partly shaken. Horace wrote that not only poets but painters as well were entitled to the privilege of daring whatever they wished to ("quod libet audendi"). In the declining period of antiquity, Philostratus wrote that "one can discover a similarity between poetry and art and find that they have imagination in common." Callistratos averred that "Not only is the art of the poets and prosaists inspired, but likewise the hands of sculptors are gifted with the blessing of divine inspiration." This was something new: classical Greeks had not applied the concepts of imagination and inspiration to the visual arts but had restricted them to poetry. Latin was richer than Greek: it had a term for "creating" ("creatio") and for "creator," and had two expressions — "facere" and "creare" — where Greek had but one, "poiein." Still, the two Latin terms meant much the same thing.[5]

A fundamental change, however, came in the Christian period: "creatio" came to designate God's act of "creation from nothing" ("creatio ex nihilo"). "Creatio" thus took on a different meaning than "facere" ("to make"), and ceased to apply to human functions. As the 6th-century Roman official and literary figure Cassiodorus wrote, "things made and created differ, for we can make, who cannot create."[6]

Alongside this new, religious interpretation of the expression, there persisted the ancient view that art is not a domain of creativity. This is seen in two early and influential Christian writers, Pseudo-Dionysius and St. Augustine. Later medieval men such as Hraban the Moor, and Robert Grosseteste in the 13th century, thought much the same way. The Middle Ages here went even further than antiquity; they made no exception of poetry: it too had its rules, was an art, and was therefore craft and not creativity.[7]

All this changed in modern times. Renaissance men had a sense of their own independence, freedom and creativity, and sought to give voice to this sense of independence and creativity. The philosopher Marsilio Ficino wrote that the artist "thinks up" ("excogitatio") his works; the theoretician of architecture and painting, Leon Battista Alberti, that he "preordains" ("preordinazione"); Raphael, that he shapes a painting according to his idea; Leonardo da Vinci, that he employs "shapes that do not exist in nature"; Michelangelo, that the artist realizes his vision rather than imitating nature; Giorgio Vasari, that "nature is conquered by art"; the Venetian art theoretician, Paolo Pino, that painting is "inventing what is not"; Paolo Veronese, that painters avail themselves of the same liberties as do poets and madmen; Federico Zuccari (1542-1609), that the artist shapes "a new world, new paradises"; Cesare Cesariano (1483-1541), that architects are "demi-gods." Among musicians, the Dutch composer and musicologist Jan Tinctoris (1446-1511) demanded novelty in what a composer did, and defined a composer as "one who produces new songs."[8]

Sarbiewski.

Still more emphatic were those who wrote about poetry: G.P. Capriano held (1555) that the poet's invention springs "from nothing." Francesco Patrizi (1586) saw poetry as "fiction," "shaping," "transformation."[9]

Finally, at long last, someone ventured to use the word, "creation." He was the 17th-century Polish poet and theoretician of poetry, Maciej Kazimierz Sarbiewski (1595-1640), known as "the last Latin poet." In his treatise, De perfecta poesi, he not only wrote that a poet "invents," "after a fashion builds," but also that the poet "creates anew" ("de novo creat"). Sarbiewski even added: "in the manner of God" ("instar Dei").[10]

Gracián.

Sarbiewski, however, regarded creativity as the exclusive privilege of poetry; creativity was not open to visual artists. "Other arts merely imitate and copy but do not create, because they assume the existence of the material from which they create or of the subject." As late as the end of the 17th century, André Félibien (1619-1675) would write that the painter is "so to speak [a] creator." The Spanish Jesuit Baltasar Gracián (1601-1658) wrote similarly as Sarbiewski: "Art is the completion of nature, as it were a second Creator..."[11]

By the 18th century, the concept of creativity was appearing more often in art theory. It was linked with the concept of imagination, which was on all lips. Joseph Addison wrote that the imagination "has something in it like creation." Voltaire declared (1740) that "the true poet is creative." With both these authors, however, this was rather only a comparison of poet with creator.[12]

File:Greuze, Portrait of Diderot.jpg
Diderot.

Other writers took a different view. Denis Diderot felt that imagination is merely "the memory of forms and contents," and "creates nothing" but only combines, magnifies or diminishes. It was precisely in 18th-century France, indeed, that the idea of man's creativity met with resistance. Charles Batteux wrote that "The human mind cannot create, strictly speaking; all its products bear the stigmata of their model; even monsters invented by an imagination unhampered by laws can only be composed of parts taken from nature." Luc de Clapiers, marquis de Vauvenargues (1715-1747), and Étienne Bonnot de Condillac (1715-1780) spoke to a similar effect.[13]

Their resistance to the idea of human creativity had a triple source. The expression, "creation," was then reserved for creation ex nihilo (Latin: "from nothing"), which was inaccessible to man. Second, creation is a mysterious act, and Enlightenment psychology did not admit of mysteries. Third, artists of the age were attached to their rules, and creativity seemed irreconcilable with rules. The latter objection was the weakest, as it was already beginning to be realized (e.g., by Houdar de la Motte, 1715) that rules ultimately are a human invention.[14]

Bergson.

In the 19th century, art took its compensation for the resistance of preceding centuries against recognizing it as creativity. Now not only was art regarded as creativity, but it alone was so regarded. When later, at the turn of the 20th century, there began to be discussion as well of creativity in the sciences (e.g., Jan Łukasiewicz, 1878-1956) and in nature (e.g., Henri Bergson), this was generally taken as the transference, to the sciences and to nature, of concepts proper to art.[15]

The start of the scientific study of creativity is sometimes taken as J. P. Guilford's 1950 address to the American Psychological Association, which helped popularize the subject.

Other students of creativity have taken a more pragmatic approach, teaching practical creativity techniques. Three of the best-known are Alex Osborn's "brainstorming" (1950s to present), Genrikh Altshuller's Theory of Inventive Problem-Solving (TRIZ, 1950s to present), and Edward de Bono's "lateral thinking" (1960s to present).

Periods and Personalities

Ancient Greece

3rd century
4th century of the Christian Era

1000s - 1500s

1200s

About 1275, in an early attempt to use logical means to produce knowledge, Ramon Llull designed a method of combining attributes selected from a number of lists, which he first published in full in his Ars generalis ultima or Ars magna (1305). This used concept structures of the mind-map form.

1470s

1500s - 2000s

There was no real demand for such a science until the 19th century, when the Industrial Revolution started:

Following along Miles’ line of thought were:

  • beginning in the mid-1940s - start of knowledge-based creativty era by TRIZ
Early 20th century
1940s
1950s
1960s
1970s
1980s
1990s
2000s

Undated

  • Reviewed Dendrogram technique, relies on the experience of designers which may be limited to certain areas of expertise such as chemistry or electronics. Thus, a solution that might be simpler and cheaper using magnetism could be missed.

Notes

  1. ^ Władysław Tatarkiewicz, A History of Six Ideas: an Essay in Aesthetics, p. 244.
  2. ^ Tatarkiewicz, p. 245.
  3. ^ Tatarkiewicz, p. 245.
  4. ^ Tatarkiewicz, pp. 245–46.
  5. ^ Tatarkiewicz, p. 246.
  6. ^ Tatarkiewicz, p. 247.
  7. ^ Tatarkiewicz, p. 247.
  8. ^ Tatarkiewicz, pp. 247–48.
  9. ^ Tatarkiewicz, p. 248.
  10. ^ Tatarkiewicz, p. 248.
  11. ^ Tatarkiewicz, p. 248.
  12. ^ Tatarkiewicz, pp. 248–49.
  13. ^ Tatarkiewicz, p. 249.
  14. ^ Tatarkiewicz, p. 249.
  15. ^ Tatarkiewicz, p. 249.

References

  • Tatarkiewicz, Władysław (1980). A History of Six Ideas: an Essay in Aesthetics. Translated from the Polish by Christopher Kasparek, The Hague: Martinus Nijhoff. (Traces the history of key aesthetics concepts, including art, beauty, form, creativity, mimesis, and the aesthetic experience.)
  • Sternberg, R.J. (1999). "The Concept of Creativity: Prospects and Paradigms". In ed. Sternberg, R.J. (ed.). Handbook of Creativity. Cambridge University Press. {{cite book}}: |editor= has generic name (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  • Albert, R.S. (1999). "A History of Research on Creativity". In ed. Sternberg, R.J. (ed.). Handbook of Creativity. Cambridge University Press. {{cite book}}: |editor= has generic name (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)