In discussing their interesting melanoma patient in Photo Rounds, Rodriguez and Khachemoune (J Fam Pract 2004; 53:541–544) review the ABCD (asymmetry, border irregularity, color variation, and diameter >6 mm) mnemonic for characteristics of melanoma. Some have proposed adding “E” and “F” to this scheme. The “E” is for both “evolution”—a change in a pre-existing lesion—and for “elevation”—vertical growth of (or a vertical component to) pigmented lesions that are usually flat (like nevi arrested in the junctional stage, as found on extremities). The “F” is for “family history,” which is another predictor of likelihood of melanoma and is especially important in individuals with clinically or histologically dysplastic nevi. Another clinical clue that can be added to the “D” is “different,” different from the company it keeps. For example, if all of the patient’s nevi are a “nice” brown, except one that is much darker, that one should be scrutinized very carefully.
In evaluating a lesion, patient characteristics may also help in clinical decision-making. “D” can also stand for “dysplastic”—if a patient has even 1 clinically dysplastic nevus, that doubles the risk of melanoma.1 If that isn’t enough, one can add “G” for “great numbers,” because even great numbers of small nevi double the risk for melanoma.1
Additionally, there is no rule that all melanomas must have all of the ABCD criteria. I have had residents tell me a lesion cannot be a melanoma because it is <6 mm. The ABCD(EFG) mnemonic is a tool to assist clinicians, not a set of criteria necessary for diagnosis.
Gary N. Fox, MD,
Mercy Health Partners Family Practice Residency, Toledo, OH