Addition Urged for Melanoma Memory Device Posted Tuesday, December 7, 2004 by arjuna

Know your ABCDEs to detect cancer, researchers suggest

By Steven Reinberg
HealthDay Reporter

TUESDAY, Dec. 7 (HealthDayNews) -- An alphabetical mnemonic that
dermatologists give to their patients to help identify melanoma, the
most virulent form of skin cancer, needs a simple addition, researchers say.

When melanoma is caught and treated early, the survival rate can be as
high as 96 percent. So it pays to look at the moles on your skin closely
for any signs of cancer. One simple way of knowing when moles may be
cancerous is the ABCD system, which has been used since 1985.

In the system, "A" stands for asymmetry, where one half of a mole
doesn't match the other half. "B" is for border irregularity, where the
edges are ragged, notched or blurred. "C" is for color that is a
nonuniform mixture of brown, black, red, white or blue. And "D" is for
diameter, especially when the mole is bigger than 6 millimeters, about
the size of a pencil eraser.

Now researchers are recommending that "E," for evolving, be added to the
list. An evolving mole is one that is changing in size, shape, and
symptoms -- such as itching or tenderness, surface bleeding, or shades
of color, according to their report in the Dec. 8 issue of the Journal
of the American Medical Association.

There will be more than 50,000 new cases of melanoma diagnosed in the
United States each year, according to the American Cancer Society, and
more than 7,000 will die from the disease.

"This ABCD acronym has been in place for almost 20 years," said lead
researcher Dr. David Polsky, an assistant professor of dermatology at
New York University Medical School. "We decided to review the medical
literature on the utility of the ABCD acronym."

After the review, Polsky and his team are recommending that E for
evolving be added to the ABCD acronym.

"This recognizes the changing nature of melanomas," he said. "We want to
recognize that more, because we think that this is a very critical
element of melanomas. We want the public to pay more attention to
changing moles."

One type of melanoma, called nodular melanoma, represents about 15
percent of this form of cancer, Polsky explained. "Nodular melanomas
don't have the ABC characteristics, but they tend to grow rapidly," he
added.

By adding "E" to the acronym, Polsky hopes these melanomas can be
diagnosed earlier. "Oftentimes because they don't have the ABC
characteristics, they're diagnosed at a more advanced stage. Since
nodular melanoma is an aggressive form of cancer, we wanted to emphasize
the changing nature of melanoma in general, and hope that this would
capture nodular melanomas earlier," Polsky explained.

"People should be examining their skin periodically," Polsky said.
"Lesions that are changing should be brought to the attention of their
doctor."

"The authors have previously made a tremendous contribution to melanoma
awareness and earlier diagnosis with their ABCD criteria," said Dr.
Jeffrey Salomon, an assistant clinical professor of plastic surgery at
Yale University School of Medicine. "Make no mistake about it, that
contribution has translated into countless lives saved."

However, Salomon cautions that the epidemic of melanoma continues and
doctors and their patients must be on the lookout for this deadly
cancer. "The addition of E is another critical stone in the wall that
separates more reliably screened people from less reliably screened
people. The recommendation is timely and should be well received and
appreciated by physicians and the lay public alike," Salomon said.

Not everyone agreed with that assessment, though.

"I think that it [adding E] is a poor suggestion," said Dr. Martin A.
Weinstock, a professor of dermatology and community health at Brown
University and chairman of the American Cancer Society's Skin Cancer
Advisory Group.

Weinstock believes that the current ABCD criteria describes some but not
all melanomas. However, tinkering with it only adds confusion, he said.

"The most important warning sign for melanoma is change in size, shape
or color of an existing mole," Weinstock said. And one should not worry
about whether it meets the ABCD criteria. "ABCD can be noted as a
description of some melanomas, but certainly not all."

More information

Get a primer on skin cancer from the American Cancer Society
.



SOURCES: David Polsky, M.D., Ph.D., assistant professor, dermatology,
New York University Medical School, New York City; Jeffrey Salomon,
M.D., assistant clinical professor, plastic surgery, Yale University
School of Medicine, New Haven, Conn.; Martin A. Weinstock, M.D., Ph.D.,
professor, dermatology and community health, Brown University,
Providence, R.I., and chairman, American Cancer Society Skin Cancer
Advisory Group; Dec. 8, 2004, Journal of the American Medical Association