A unifying approach to the clinical diagnosis of melanoma including “D” for “Dark” in the ABCDE criteria

Abstract

Current clinical approaches to melanoma diagnosis have not been associated with a decrease in mortality from this cancer. The components of the new approach presented are, first, a screening examination to look for any lesion that stands out because of being dark, different, or changing; second, when a single lesion is recognized to be of concern for any reason, that lesion is then evaluated in more detail utilizing the ABCDE criteria, with the “D” signifying “Dark” and not “6 mm Diameter” in this mnemonic; and, third, additional discussion of the “ugly duckling” sign and of the recognition of nodular melanomas. Since the Georgia Society of Dermatology and Dermatologic Surgery was the first state or national society to endorse this approach, I refer to it as the Georgia approach.

Thickness and Diameter in Melanoma: Is There a Relation?

“…However, SM may have a diameter smaller than this cutoff (8). For this reason it has been proposed to eliminate the 6-mm criterion in the ABCDE system (9) and substitute dark for diameter to denote the letter D (3).…”

“…However, the presence of very small (≤6 mm diameter) SM has prompted the reconsideration of the role of diameter (2). Recently, a change of the meaning of the letter D – from diameter to dark – has been proposed (3). A relationship between the diameter and the thickness of SM would strengthen the clinical relevance of diameter in the ABCDE system.…”

Comparison of distance metric measures to differentiate non-dermoscopic skin lesions

“…R.J. Friedman et al [4] designed the ABCD criteria for melanoma screening to facilitate early diagnosis of cutaneous melanoma. These characteristics can be assessed according to the ABCDE clinical rule [5], the ABCDEF rule [6], the ABCD rule of dermatoscopy [7] or other methods. ABCDEF is an acronym for Asymmetry, irregular Border, at least three different Colors, Diameter, Evolution (i.e.…”

Melanoma recognition using extended set of descriptors and classifiers

“…Some recently published strategies have rejected the diameter criterion as well as abandoned all or portions of the ABCDE mnemonics [3][4][5]. The additional problems with application of the ABCDE descriptors appear for extensive lesions, for which the borders of lesions are outside the dermoscopic image or there is a smooth transition between the lesions and the healthy skin.…”

“…These realities combined with increasing evidence of the lack of efficacy of the clinically assessed ABCDE criteria ("A" for "asymmetry," "B" for "border irregularity," "C" for "color variation," "D" for "diameter," and "E" for "evolving lesions") have necessitated ongoing efforts to enhance the earlier clinical detection of melanoma [3,4].…”