Cutaneous Melanoma: Preoperative Tumor Diameter in a General Dermatology Outpatient Setting

Abstract

Almost one-third of evaluable tumors in this general dermatology practice-based setting had a preoperative diameter of 6 mm or less, and two-thirds of these small-diameter cases were invasive. The diameter criterion of greater than 6 mm in the ABCD mnemonic is precariously insensitive for a public message.

An integrated clinical‐dermoscopic risk scoring system for the differentiation between early melanoma and atypical nevi: the iDScore

“…This statistics are in line with the currently accepted threshold of 6 mm for 'D'-dimensionparameter accepted for clinical screening that correlates between tumour size and Breslow thickness. 46,47 However, as highlighted in a recent a multicentric study on 1610 MMs, the association 'MM dimension-Breslow thickness' becomes evident when the maximum lesion diameter is >1 cm, while it is less strong for small MMs <6 mm or micromelanomas <4 mm. 48 Thus, in case of micromelanomas with few or absent atypical pattern analysis features, 7 neither dermoscopic nor dimension parameters are helpful, and other objective variables such as age and body area have to be taken into account.…”

“…lower extremities including legs, ankles and back of the feet), and a partial score S = 1 to group C of seldom photoexposed body areas (i.e. 46,47 However, as highlighted in a recent a multicentric study on 1610 MMs, the association 'MM dimension-Breslow thickness' becomes evident when the maximum lesion diameter is >1 cm, while it is less strong for small MMs <6 mm or micromelanomas <4 mm. These findings statistically reflect the two main trends actually observed in epidemiologic studies on in situ MM, with a majority of cases directly linked to sun exposure and a quote of cases developed independently from UV-exposure rates.…”

Computer-assisted measurement of primary tumor area is prognostic of recurrence-free survival in stage IB melanoma patients

“…tumor diameter) measured in vivo is typically used as a screening tool in melanoma, where suspicious lesions with a diameter greater than 6 mm have a higher likelihood of being melanoma than those less than 6 mm. 22 – 24 In regard to prognostic value, past studies have noted a correlation between the primary tumor diameter and survival. 25 – 30 Breslow’s landmark 1970 study found that no primary melanomas less than 5 mm in clinical diameter recurred or metastasized.…”

Is a preoperative tumor diameter of 6 mm or less reliable in excluding a diagnosis of melanoma?

“…Other published studies in which preoperative diameter was available report that small diameter tumors (ie, 6 mm or less) comprise 25% to 33% of cases. 2 During the past decade, small diameter melanomas are increasing in frequency. 3 Currently, the D criterion in the ABCD mnemonic would omit 25% to 33% of melanomas.…”

“…There are additional reasons why individual components of the ABCD mnemonic, including the diameter criterion, are dangerously insensitive as a melanoma screening message. 2 …”