Marghoob, Slade, Kopf, Rigel, and Friedman

 
"The goal of public education is to find melanomas while they are macular (nonelevated) and thus wholly in situ or histologically thin. It should be stressed that the ABCD rule was developed to describe features of early, thin (clinically flat) melanoma . . ."
 
"Lastly, on review of the New York University-database, a diameter of 6 mm was chosen as the cutoff for defining the "D" of the ABCDs. The reason for this cutoff was based on the consistency of finding the A, B, and Cs (of the ABCD rule) in lesions that were larger than 6 mm. Obviously, if the cutoff diameter is reduced from 6 to 4 mm the sensitivity of detecting melanoma will increase but the specificity will decrease . . ."
 
Marghoob AA, Slade J, Kopf AW, Rigel DS, Friedman RJ. The ABCDs of melanoma: Why change? J Am Acad Dermatol 1995 April; 32(4):682–84.
 

Brief critique

 
The group from New York University continues to advocate the ABCDs, the passion it brings to it not being unexpected for proselytes. Melanoma, morphologically, i.e., clinically and histopathologically, is melanoma irrespective of whether it is 6 mm or 4 mm (the number 6 mm derived from the assessment prematurely and by conventional microscopy of Ackerman in the early 1980s as recorded on page 228). Just as time was, as recently as 1990 in the December issue of Human Pathology, when leading dermatopathologists with an interest in proliferation of melanocytes averred that "the term melanoma in situ should be used with caution, if at all,"2 so, too, it is with diagnosis of melanoma when lesions are small and flat. Time was when no clinician, no matter how able, would consider diagnosing melanoma when it was flat, no matter its breadth in greatest diameter. In the future it doubtlessly will be possible to diagnose melanoma clinically when lesions of it are smaller than 4 mm, just as it is possible to do that histopathologically for melanoma that is in situ.