The clinical diagnosis of early malignant melanoma: Expansion of the ABCD criteria to improve diagnostic sensitivity

With the steady increase in incidence of malignant melanomas (MM) in the United States, early diagnosis and complete removal are critical for the containment of the malignancy.[1] The "ABCD" method of identification, originally described by Friedman et al., has been a useful tool in facilitating the diagnosis of MM.[2,3,4] This method analyzes four clinical characteristics to identify a malignant melanoma: Asymmetry, Border irregularity, Color variegation, and a Diameter of 6 mm or more.[4] Clinicians recognize that some melanomas lack all or most of the features defined in the "ABCD" rules.[5] This may be especially true of some early invasive and in situ melanomas. [6,7] In these instances, clinical history documenting morphologic change over time can be an important additional consideration. The following case reports underscore the need to expand the ABCD mnemonic to include an "E" for "Evolutionary change." An additional modification is also needed to emphasize the need for a low threshold for biopsy of unusual lesions which do not show typical benign features, even if they do not meet the ABCDE criteria. To this end we propose an "F" for "Funny looking lesions".