Although melanoma is the least common skin cancer, it is the most lethal due to its high rate of metastasis and high mortality at advanced stages. Melanoma causes over 70% of skin cancer deaths. Therefore, it is very important for clnicians to be able to screen for melanoma to catch it in its earliest possible stages.
Clinicians should apply the ABCDE method when screening moles for melanoma (this does not apply for nonmelanocytic lesions like seborrheic keratoses).
The ABCDE Rule
If two or more of the ABCDE criteria are present, the risk of melanoma increases and biopsy should be considered. Some have suggested adding EFG (ABCDE-EFG) to help detect aggressive nodular melanomas.
Asymmetry- Of one side of the mole compared to the other
Border irregularity- Especially if ragged, notched, or blurred
Color variations- More than two colors, especially blue-black, white, or red
Diameter > 6mm- Approximately the size of a pencil eraser
Evolving- Or changing rapidly in size, symptoms, or morphology.
Some clinicians add EFG to the ABCDE to get ABCDE-EFG
Firm to palpation
Growing progressively over several weeks
A Few Notable Points
With the exception of a homogeneous blue color in a blue nevus, blue or black color within a larger pigmented lesion is especially concerning for melanoma.
Early melanomas may be < 6mm, and many benign lesions are > 6mm.
Evolution, or change, is the most sensitive of all the criteria. A reliable history of change may prompt biopsy of a benign-appearing lession.
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