Beyond ABCDs for Melanoma

The month of May marked 25 years since dermatologists began using the ABCD rule to help screen for melanoma, and advances in diagnosis since then have leaned toward newer and better use of imaging technology instead of clinical mnemonics.

Left side, top to bottom: melanomas showing (A) asymmetry, (B) irregular border, (C) unusual coloring, and (D) diameter that had changed in size. Right column: Normal moles. Images from National Cancer Institute via Skin Cancer Foundation, merged by WikiMedia Commons user Stevenfruitsmaak.

You do know your ABCDs, don’t you? Moles with “A” for asymmetry, “B” for border irregularity, “C” for uneven color, or “D” for diameter greater than 6 mm. If you see these, think melanoma.

Advances over the quarter-century since then have focused on helping physicians “see” melanoma better. Dr. Darrel Rigel described some of these at the annual meeting of the American Society for Mohs Surgery. Dermoscopy allowed non-invasive imaging of melanomas. Digital photography came along, and some dermatologists began using serial digital imaging to track changes in moles over time. Most recently, various groups have been trying to add assessments using infrared (non-visible) light through computer-aided programs to aide diagnosis.

As a woman of letters, I have to admit a fondness for the ABCDs. But the imaging advances do have more of a new-school, digital-age feel to them. I think both can happily co-exist in dermatology. Time will tell if that’s old-school thinking as the digital age advances.

—Sherry Boschert (@sherryboschert on Twitter)
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Filed under Dermatology, Family Medicine, Geriatric Medicine, IMNG, Internal Medicine, The Mole

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