What is ABCDE melanoma (Asymmetry, Border, Color, Diameter, Evolving)?

From the Guidelines

ABCDE melanoma diagnosis should be based on the criteria of asymmetry, irregular borders, heterogeneous color, large diameter, and evolution, as outlined in the British Journal of Cancer study 1. When evaluating a pigmented cutaneous lesion for potential melanoma, it is crucial to consider these specific characteristics. The criteria are classified as follows:

• Asymmetry: one half of the lesion doesn't match the other
• Irregular borders: edges are ragged or notched
• Heterogeneous color: multiple colors within the same lesion
• Large diameter: larger than a certain size, with evolution being a recent change that must co-exist with at least one of the preceding criteria. Early detection of melanoma significantly improves treatment outcomes, as melanoma is the most dangerous form of skin cancer due to its potential to spread rapidly to other parts of the body if not caught early, as noted in the study 1. Regular skin self-examinations using the ABCDE rule, along with annual professional skin checks for those at higher risk, are essential preventive measures. Risk factors include fair skin, history of sunburns, excessive UV exposure, family history of melanoma, and having many moles or unusual moles. Epiluminescence microscopy (ELM), or dermatoscopy, can improve the clinical diagnosis of pigmented lesions, but its accuracy depends on the experience of the dermatologist, and it should only be used by those familiar with the technique, as stated in the study 1. The standard practice for the management of cutaneous melanocytic lesions thought to be malignant is a limited but complete excision under local anaesthetic of the lesion with a narrow rim of normal skin, as recommended in the study 1. Key points to consider in the management and diagnosis of melanoma include:
• The importance of early detection and prompt evaluation by a dermatologist
• The use of the ABCDE criteria for identifying potential melanoma skin lesions
• The role of epiluminescence microscopy in improving clinical diagnosis
• The standard practice for excising cutaneous melanocytic lesions thought to be malignant.

From the Research

ABCDE Melanoma Criteria

The ABCDE criteria are used to identify malignant melanoma, analyzing four clinical characteristics:

• Asymmetry
• Border irregularity
• Color variegation
• Diameter of 6 mm or more 2, 3

Expansion of ABCDE Criteria

Some studies suggest expanding the ABCDE criteria to include an "E" for "Evolutionary change" to improve diagnostic sensitivity, as some melanomas may lack all or most of the features defined in the "ABCD" rules 2, 3.

• This expansion emphasizes the significance of evolving pigmented lesions in the natural history of melanoma
• Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms, surface, and shades of color 3

Clinical Application of ABCDE Rule

The ABCDE rule systematizes warning signs for malignant melanoma, and its application can help in early detection of MM 4.

• A higher number of ABCDE signs are associated with a greater chance of MM being first suspected by a non-dermatologist
• However, relying on the ABCDE rule alone might result in missing early MM lesions 4

Diagnosis and Treatment of Melanoma

Melanoma represents the most aggressive and deadliest form of skin cancer, and its treatment includes surgical resection, chemotherapy, photodynamic therapy, immunotherapy, biochemotherapy, and targeted therapy 5.

• Immunotherapy is a cornerstone in the treatment of melanoma, intended to modulate the host immunity against the tumor 6