|
| Fig. 45.1 Classic malignant melanoma demonstrating asymmetry, irregular notched border, multiple colors, wide diameter, and a history of change and growth (evolution). |
The development of a new or changing pigmented lesion is the classic initial presentation of melanoma. A lesion that demonstrates a noticeable increase in size over a period of weeks to months or development of pigment irregularity (black, hues of brown, red, blue, or white) should be evaluated by a physician and biopsied. The ABCDEs of melanoma (Fig. 45-1) are a helpful guideline for determining which moles could be suspicious for
- Asymmetry. Any mole that appears unusual or shows asymmetry in shape should be evaluated.
- Border and bleeding. The border of any melanocytic nevus should be relatively smooth, with a clear demarcation between the nevus and surrounding normal skin. Nevi that develop irregular or ill-defined borders should be evaluated. B is also for bleeding, and any mole that bleeds needs careful evaluation.
- Color. Most moles have a homogeneous tan or brown color. Moles that develop pigment variegation within an otherwise homogeneous background should be evaluated.
- Diameter. Most melanomas are 0.6 mm in diameter, but an otherwise suspicious lesion that is small might also be malignant.
- Evolving. This emphasizes the need to evaluate any melanocytic nevus is whether the nevus has changed in terms of the ABCDs over a relatively short time (weeks to months).
It should be stressed that the ABCDEs are meant strictly as guidelines and cannot take the place of a thorough evaluation. Some physicians stress utilizing the “ugly duckling” sign. The latter refers to the fact that nevi in an individual generally tend to share a similar appearance, so one that does not share the same characteristics should be considered for biopsy.
Abbasi NR, Shaw HM, Rigel DS, et al: Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria,
JAMA 292:2771–2776, 2004.
