< Current issue
Dermatopathology: Practical & Conceptual July - September 2001
Evolution in Thinking: Criteria for Clinical Diagnosis of Melanoma, 1947–2000: A Critique in Historical Perspective
Mary Aldrene L. Tan, M.D.
A. Bernard Ackerman, M.D.
Becker and Obermayer
Ormsby and Montgomery
Sulzberger and Wolf
Pillsbury, Shelley, and Kligman
Fitzpatrick and Clark
Lewis and Wheeler
Callen, Stawiski, and Voorhees
Roses, Harris, and Ackerman
Dobson and Abele
Friedman, Rigel, and Kopf
Fitzpatrick, Rhodes, Sober, and Mihm
Koh and Rogers
McCarthy et al.
Mooi WJ and Krausy
Fitzpatrick, Milton, Balch, Shaw, McCarthy, and Sober
National Institutes of Health Consensus Conference
Holzle, Kind, Plewig, and Burgdorf
Marghoob, Slade, Kopf, Rigel, and Friedman
Arndt, Wintroub, Robinson, and LeBoit
Elder and Elenitsas
Maize et al.
Langley, Fitzpatrick, and Sober
Farmer and Hood
Fleischer, Feldman, Katz, and Clayton
Ackerman, Kerl, Sánchez, et al.
Friedman, Rigel, and Kopf
"The clinically diagnostic features of early malignant melanoma (malignant melanoma in situ) are similar regardless of the anatomical site. It is essential that physicians recognize these features. Unlike benign pigmented lesions, which are generally round and symmetrical, early malignant melanomas are usually asymmetrical. Unlike benign pigmented lesions, which generally have regular margins, the borders of early malignant melanomas are usually irregular. Unlike benign pigmented lesions, which are generally uniform in color, macular malignant melanomas are variegated, ranging from various hues of tan and brown to black, and sometimes intermingled with red and white. Unlike most benign pigmented lesions, which generally have diameters less than six mm, the diameters of macular malignant melanomas when first identified are often more than six mm.
The characteristic clinical features of early malignant melanoma can be easily remembered by thinking of
= Border irregularity.
= Color variegation.
= Diameter generally greater than six mm."
Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: The role of physician examination and self-examination of the skin.
CA Cancer J Clin
1985 MayJune; 35(3): 1356.
The ABCDs enunciated by Friedman, Rigel, and Kopf are the very same criteria that Ackerman first advocated for clinical diagnosis of melanoma in 1981 and then again in 1983 and 1985, although by 1985 he avoided scrupously terms like "regular" and "irregular" for description of margins, the reason being that those terms have never been defined lucidly. Although Friedman, Rigel, and Kopf opined that "It is essential that physicians recognize these features," the "easily remembered" ABCDs soon became the vehicle by which physicians taught patients to recognize melanomas. But "thinking of ABCD" was not the same as thinking
the ABCDs, either for physicians or patients; when critical thought is given to the subject, the mnemonic is found not merely to be simple, but simplistic and misleading.
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