< Current issue
Dermatopathology: Practical & Conceptual October - December 2006
3. New Heights: An unabridged history of the ABCDs
Michael Wile, M.D.
The history of the ABCDs prompts the raising of certain ethical questions, some of which have been addressed by Ackerman. For one example, when describing the consistent failure of the ABCDs to lead to a correct diagnosis of melanoma in prepubescents, he advised the following:
"That reality should give pause to colleagues conscionable socially; to employ criteria for matters that pertain to life and death and which do not work hardly, is not consonant with the obligation of a physician to a patient. For purposes practical, the ABCDs do not work at all for discrete papules of melanoma such as those that are the presentation, nearly exclusively, of melanoma in prepubescents. It is long past due for dermatologists, in cooperation with dermatopathologists and without wielding a dermatoscope, to establish criteria clinical for melanoma that actually work."
For another example is the fact that the ABCDs originally were created as a device for use by the laity, not for utilization by physicians. It was only later that physicians took them over and became staunch advocates. On the website
in a "Lesson" to Interactive Quiz 338 pertinent to a Clark's nevus, Ackerman contended that
"This lesion fulfills the ABCDs hyped by the American Cancer Society and the American Academy of Dermatology as being criteria dependable for clinical diagnosis of melanoma, the mnemonic having been created originally for use by the laity, not by physicians."
] That sequence, in the view of Ackerman, is just the reverse of what it should be. That, however, does not seem to be an impediment to Friedman, who, on June 16th at the 23rd Annual Symposium, "Advances in Dermatology" sponsored by the Ronald D. Perelman Department of Dermatology at New York University School of Medicine, is scheduled to give a lecture titled by him,
"Small melanomas: the ABCDE's or Bust!"
Last, the history of the ABCDs should serve as a poignant reminder to colleagues to cite, properly, the work of others. In the 23 references listed in the editorial [
] that served as a springboard for this "unabridged history," not a single one was to the work of Ackerman, not in 1980 in
] not in 1981 in
Pathology of Malignant Melanoma
] not in any of his many publications relevant to the ABCDs, not in any Interactive Quiz, not in any video, not in any poster—none. Relevant to the matter is the fact that in the April issue of the
Archives of Dermatology
for 2006, two Letters to the Editor, both of them critical of the
were published, [
] Rigel, et al., responding to them in part by stating that
"the ABCDs of melanoma were developed by our group in 1985 when we perceived a significant problem."
] Twenty references,
were provided by the authors of the two letters and by the respondents; not a single one was to the writings of Ackerman. All of this ballyhoo is not bothersome to Ackerman, but it is to me—and should be to editors of medical journals, they being responsible for maintaining standards in a profession that is supposed to be noble and learned.
* Dr. Ackerman kindly permitted me to interview him during my preparation of the manuscript and made helpful suggestions.
Michael Wile, M.D., is a dermatopathologist at Quest Diagnostics in Henderson, Nevada. This article was reviewed by Harald Kittler, M.D., and Bruno E. Paredes, M.D. Contact author via e-mail:
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