The "Ugly Duckling" Sign: An Early Melanoma Recognition Tool For Clinicians and the Public

Alon Scope, MD; Ashfaq A. Marghoob, MD


The Melanoma Letter. 2007;25(3):1-3. 

In This Article

The ABCDEs — What It Can and Can't Do

The ABCD acronym, introduced in 1985 and expanded to ABCDE in 2004, represents an analytical method for the evaluation of melanocytic lesions that clinicians and the general public can utilize to help detect MM early.[3] Melanoma often manifests some or all of the ABCDE features, namely asymmetry (A), border irregularity (B), color variability (C), diameter greater than 6 mm (D), and evolution or change (E).[4] However, clinicians diagnosing potential skin cancers face the challenge of trying to distinguish MM from many other clinically atypical nevi, which also often display some or all of the ABCDE criteria. In addition, relying solely on the ABCDE approach may result in overlooking MMs that are smaller than 6 mm in diameter or lack the ABCDE criteria.[5] The relatively low sensitivity of clinical diagnosis of MM even among dermatologists[6] underscores the not inconsequential risk of missing the disease and highlights the need for improved strategies to enhance recognition.


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