Fitzpatrick, Rhodes, Sober, and Mihm

 
"The three physical signs of importance [for diagnosis of malignant melanoma] are variegated colour, irregular border and increase in size. To simplify the approach to the public, a simple check-list of the signs of the signs of early melanoma has been developed. In modification of this guide we have added another sign of melanoma: 'E' for elevation—a usual feature of the majority of melanomas. Surface elevation occurs in the form of either uniformly raised lesions (plaques) or discrete single or multiple elevated lesions, papules, nodules; elevation can often be detected only by viewing the whole lesion with oblique illumination or 'side-lighting'. There are five signs of malignant melanoma: (A) asymmetry in shape—one half unlike the other; (B) border is irregular—edges scalloped and/or not sharply demarcated; (C) colour is mottled—haphazard display of colours: shades of brown, blue-grey, black, pink and white, or uniformly black; (D) diameter—large; (E) elevation of surface, subtle or obvious, assessed by side-lighting. This 'ABCDE' guide to the signs of melanoma is simple and recommended as a means of education for patients and medical personnel (i.e. physicians, nurses, medics)."
 
Fitzpatrick TB, Rhodes AR, Sober AJ, Mihm MC Jr. Primary malignant melanoma of the skin: The call for action to identify persons at risk; to discover precursor lesions; to detect early melanomas. In: Elwood JM, ed. Pigment Cell 1988;9:110–17.
 

Brief critique

 
The addition of "E" to the ABCDs is retrogressive. If one really wanted to "simplify the approach to the public" for the purpose of diagnosis clinically of "early melanoma," the mnemonic would be ABCDF, the "F" standing for flat. Once a melanoma is elevated (E), it has capability, at least theoretically, for metastasis. To stress elevation, rather than flatness (F), was not the best "means of education for patients and medical personnel."