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New ABCDE of melanoma

<p>Update of the<span> ABCDE mnemonic for melanoma.</span></p>

Update of the ABCDE mnemonic for melanoma.

 

The “ABCDE” prompt for melanoma diagnosis is a helpful mnemonic. An alphabetized list is as simple as it gets, and may help diagnose melanomas and save lives.

Since its proposal in 1985, however, it has had a glaring flaw.

The “D” is for diameter greater than 6 mm, which was included because most melanomas are greater than 6 mm in width at diagnosis. However, this criteria is misleading. It may falsely reassure a patient, leading to delayed diagnosis. Certainly, many (it could be argued all) melanomas start smaller than 6 mm, and it is always preferable to catch melanoma earlier rather than later.

A criteria that currently does not exist in the mnemonic is “different.” Is the lesion in question different than the other moles on your body? This is the “ugly duckling” sign, which is one of the most useful characteristics of lesions concerning for melanoma, especially in patients with numerous moles. “Diameter” should be scrapped and “different” adopted.

 

A     Asymmetry: is one side different than the other?

B     Border: is the edge notched, irregular, or poorly defined?

C     Color: are there various shades of black, brown, gray, blue, or other colors?

D     Different: is it different than other lesions on your body?

E     Evolution: has it changed over time?

 

Note: a similar proposal was made in 2015 by Jensen and Elewski to add an “F” to the ABCDE mnemonic for “funny looking.” While a useful alternative, it is longer, and doesn’t accurately capture the “ugly duckling” sign. For example, some patients have dozens of “funny looking” moles.  Also, it maintains the “diameter” criteria, which should be eliminated.

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