The four criteria set forth by Langley, Fitzpatrick, and Sober are even less helpful for diagnosis of very early lesions of melanoma than the ABCDs. In common with the ABCDs is "(1) variegation in color," which is the C of the ABCDs, and (2) "An irregular border with identations" which is the B in the ABCDs. By the time a melanoma has "an irregular, raised surface," there is no assurance it can be cured by simple excision, and by the time there is "ulceration of the surface epithelium," there is little chance for cure; metastasis has already occurred. In short, although neither a nodule nor a tumor is mentioned among these "hallmarks of melanoma," the co-authors continue to trumpet ABCDE, the E standing for elevated. This is poor pedagogy for patients and for physicians who should be instructed about recognizing melanomas at a stage before they have metastasized and, therefore, are curable surgically.