Researchers Suggest Added Sign for Melanoma

"E" for Evolving Advised for ABCD Warning Acronym Regarding Skin Moles

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Dec. 7, 2004 -- Moles that change or evolve -- shrink, grow larger, change color, start itching or bleeding -- should be checked for possible melanoma, a new study shows.

The incidence and mortality of melanoma is increasing in the U.S., according to researchers, most recently increasing from 7.5 cases per 100,000 in 1973 in white people to 22.6 cases per 100,000 in 2001. Because public awareness helps increase detection, strategies to increase early diagnosis is a healthy priority.

It's prompting researchers to advise adding another letter "E" to the "ABCD" warning signs of melanoma.

What's ABCD mean? It's an acronym developed in 1985, to give doctors and the rest of us an easy-to-remember guide to melanoma symptoms. These include moles that have the following characteristics:

  • Asymmetry: One half doesn't match the other half.
  • Border irregularity: The edges are ragged, notched, or blurred.
  • Color: The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Changes in color distribution, especially the spread of color from the edge of a mole into the surrounding skin, also are an early sign of melanoma.
  • Diameter: The mole or skin growth is larger than 0.2 inches, or about the size of a pencil eraser. Any growth of a mole should be of concern.

The letter "E" for evolving should be added to that acronym, write researcher Naheed R. Abbasi, MPH, MD, a professor of dermatology at New York University School of Medicine, and colleagues. Their latest report appears in this week's issue of the Journal of the American Medical Association (JAMA).

In the report, Abbasi and colleagues review all research since 1985 to ensure that ABCD still holds up in diagnosing melanoma. They also looked for other patterns among patients diagnosed with melanoma. For example, one study of 125 patients showed that 78% of lesions changed or evolved in those diagnosed with melanoma, he writes. The term "evolving" subsumes the concept of change, enlargement, and elevation, he writes.

Evolving means change in:

  • Size -- growing larger or smaller
  • Shape
  • Shade of color
  • Bleeding
  • Feel - itching, tenderness

Not all melanoma moles have all ABCDE traits, Abbasi notes. However, moles with any of these characteristics should be checked by a dermatologist, he writes.

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SOURCES: Abbasi, N. Journal of the American Medical Association (JAMA), Dec. 8, 2004; vol 292: pp 2771-2776. WebMD Medical Library: Healthwise, "Skin Cancer, Melanoma, Signs."
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