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‘Ugly DUC-ling’ criteria may increase early detection of melanoma
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NEW YORK — Expanded diagnostic criteria that include identification of different, uneven or changing lesions can enhance sensitivity for early detection of melanoma, according to study results presented at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
ABCD criteria (asymmetry, border irregularity, color variegation and diameter >6 mm) have served as the standard for detecting the presence of early cutaneous melanoma. Evolution of lesions was added to diagnostic criteria in 2004.
However, many early melanomas are of smaller diameter and demonstrate more subtle clinical features, according to researchers.
Sarah Yagerman
“Our study highlights the importance of differential recognition, unevenness of distribution of colors and texture within a lesion, and changes in lesions for early melanoma detection,” Sarah Yagerman, BS, of the Dermatology Service at Memorial Sloan-Kettering Cancer Center, told HemOnc Today.
Yagerman and colleagues evaluated all cases of primary melanoma diagnosed by one investigator at their institution during a 6-year period.
The researchers evaluated 237 lesions — 92 invasive and 145 in situ — for presence of ABCD criteria. They then analyzed all lesions for uneven color and texture distribution.
“We separated the definition of asymmetry into contour, which is the silhouette of the lesion, and content, which is color distribution and texture,” Yagerman said.
The investigation revealed 65% of lesions demonstrated asymmetry contour, 94% demonstrated asymmetry content and 86% had border irregularity. Forty-seven percent of lesions had significant color variegation, defined as three or more colors, and 28% of lesions measured less than 6 mm.
The researchers observed no differences in ABCD criteria between physician-detected melanomas (n=198) and patient-detected melanomas (n=36).
Yagerman and colleagues concluded that many melanomas identified in their investigation lack classic ABCD criteria.
Emphasis on unevenness of color and texture distribution, as well as consideration of two other factors — the presence of different lesions, as well as those with a history of change — can enhance sensitivity for melanoma detection, they said.
The researchers also proposed a new acronym that encompasses differential, analytical and comparative cognition strategies.
“We’re hunting for the ‘ugly DUC-ling’ — differential recognition, unevenness of morphology and changing lesions,” Yagerman said. “We think we have a sensitive way to detect melanoma early. We need to go back and evaluate some benign lesions to determine the specificity of this approach.”
For more information:
Yagerman S. Abstract #7. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 22-23, 2013; New York.
Disclosure: Yagerman reports no relevant financial disclosures.