Context The incidence of cutaneous melanoma has increased over the past several
decades, making its early diagnosis a continuing public health priority. The
ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym
for the appraisal of cutaneous pigmented lesions was devised in 1985 and has
been widely adopted but requires reexamination in light of recent data regarding
the existence of small-diameter (≤6 mm) melanomas.
Evidence Acquisition Cochrane Library and PubMed searches for the period 1980-2004 were conducted
using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were
also used to identify additional relevant information.
Evidence Synthesis Available data do not support the utility of lowering the diameter criterion
of ABCD from the current greater than 6 mm guideline. However, the data support
expansion to ABCDE to emphasize the significance of evolving pigmented lesions
in the natural history of melanoma. Physicians and patients with nevi should
be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness),
surface (especially bleeding), and shades of color.
Conclusions The ABCD criteria for the gross inspection of pigmented skin lesions
and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to
include “evolving”). No change to the existing diameter criterion
is required at this time.