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Addition Urged for Melanoma Memory Device

Know your ABCDEs to detect cancer, researchers suggest

TUESDAY, Dec. 7, 2004 (HealthDayNews) -- An alphabetical mnemonic that dermatologists give to their patients to help identify melanoma, the most virulent form of skin cancer, needs a simple addition, researchers say.

When melanoma is caught and treated early, the survival rate can be as high as 96 percent. So it pays to look at the moles on your skin closely for any signs of cancer. One simple way of knowing when moles may be cancerous is the ABCD system, which has been used since 1985.

In the system, "A" stands for asymmetry, where one half of a mole doesn't match the other half. "B" is for border irregularity, where the edges are ragged, notched or blurred. "C" is for color that is a nonuniform mixture of brown, black, red, white or blue. And "D" is for diameter, especially when the mole is bigger than 6 millimeters, about the size of a pencil eraser.

Now researchers are recommending that "E," for evolving, be added to the list. An evolving mole is one that is changing in size, shape, and symptoms -- such as itching or tenderness, surface bleeding, or shades of color, according to their report in the Dec. 8 issue of the Journal of the American Medical Association.

There will be more than 50,000 new cases of melanoma diagnosed in the United States each year, according to the American Cancer Society, and more than 7,000 will die from the disease.

"This ABCD acronym has been in place for almost 20 years," said lead researcher Dr. David Polsky, an assistant professor of dermatology at New York University Medical School. "We decided to review the medical literature on the utility of the ABCD acronym."

After the review, Polsky and his team are recommending that E for evolving be added to the ABCD acronym.

"This recognizes the changing nature of melanomas," he said. "We want to recognize that more, because we think that this is a very critical element of melanomas. We want the public to pay more attention to changing moles."

One type of melanoma, called nodular melanoma, represents about 15 percent of this form of cancer, Polsky explained. "Nodular melanomas don't have the ABC characteristics, but they tend to grow rapidly," he added.

By adding "E" to the acronym, Polsky hopes these melanomas can be diagnosed earlier. "Oftentimes because they don't have the ABC characteristics, they're diagnosed at a more advanced stage. Since nodular melanoma is an aggressive form of cancer, we wanted to emphasize the changing nature of melanoma in general, and hope that this would capture nodular melanomas earlier," Polsky explained.

"People should be examining their skin periodically," Polsky said. "Lesions that are changing should be brought to the attention of their doctor."

"The authors have previously made a tremendous contribution to melanoma awareness and earlier diagnosis with their ABCD criteria," said Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine. "Make no mistake about it, that contribution has translated into countless lives saved."

However, Salomon cautions that the epidemic of melanoma continues and doctors and their patients must be on the lookout for this deadly cancer. "The addition of E is another critical stone in the wall that separates more reliably screened people from less reliably screened people. The recommendation is timely and should be well received and appreciated by physicians and the lay public alike," Salomon said.

Not everyone agreed with that assessment, though.

"I think that it [adding E] is a poor suggestion," said Dr. Martin A. Weinstock, a professor of dermatology and community health at Brown University and chairman of the American Cancer Society's Skin Cancer Advisory Group.

Weinstock believes that the current ABCD criteria describes some but not all melanomas. However, tinkering with it only adds confusion, he said.

"The most important warning sign for melanoma is change in size, shape or color of an existing mole," Weinstock said. And one should not worry about whether it meets the ABCD criteria. "ABCD can be noted as a description of some melanomas, but certainly not all."

More information

Get a primer on skin cancer from the American Cancer Society.

SOURCES: David Polsky, M.D., Ph.D., assistant professor, dermatology, New York University Medical School, New York City; Jeffrey Salomon, M.D., assistant clinical professor, plastic surgery, Yale University School of Medicine, New Haven, Conn.; Martin A. Weinstock, M.D., Ph.D., professor, dermatology and community health, Brown University, Providence, R.I., and chairman, American Cancer Society Skin Cancer Advisory Group; Dec. 8, 2004, Journal of the American Medical Association
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