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AAD task force reviews strengths, weaknesses of ABCDEs of melanoma

The American Academy of Dermatology Ad Hoc Task Force for the ABCDEs of Melanoma, chaired by Hensin Tsao, MD, PhD, reviewed the mnemonic for early detection of melanoma and determined it has strengths and weaknesses.

The ABCDE mnemonic includes A = asymmetry, B = border, C = color, D = diameter and E = evolving. The individual ABCDE criteria display sensitivities of 57%, 57%, 65%, 90% and 84%, and specificities of 72%, 71%, 59%, 63% and 90%, respectively, when used by dermatologists for diagnosing melanoma.

Hensin Tsao

The reviewers specifically looked at the use of the diameter (D) criterion and whether it should be revised to include melanomas smaller than 6 mm. They reported that studies have found melanomas smaller than 6 mm ranged from 2.2% to 22% of the lesions biopsied. The task force members added that small diameter might not be indicative of early melanoma and invasiveness.

They also reviewed alternate mnemonics for subtypes of melanoma, including ABCDEF for subungual melanoma, and additional ABCD criteria for pediatric melanoma. Other detection tools for early melanoma, including the Glasgow seven-point checklist, were reviewed.

“Although the diagnostic accuracy of ABCDEs has been verified in clinical practice and are a useful tool when used by dermatologists, to our knowledge, no randomized clinical trial has been performed to demonstrate that using the ABCDE criteria improves the ability to perform early detection by the public,” the task force concluded. “Further research will be important to determine if the ABCDE criteria should be altered or set aside in favor of a newer paradigm.”

The task force also stated that, like any tool, the ABCDEs have their strengths and limitations; however, for the present time, they remain a valuable component in the process of early detection of skin cancer. – by Bruce Thiel

Disclosure: Tsao served as an investigator for MelaScience, receiving equipment, and as a consultant to Scibase, receiving honoraria. Please see the full study for a list of all other authors’ relevant financial disclosures.