Darkness May Trump Diameter in Melanoma Dx

Studies show that patients find their melanomas more often than physicians do. Unfortunately, the lesions found by patients are likely to be deeper or more advanced than those that physicians find. “The fact that patients would monitor for smaller lesions and start the process of getting in to see the doctor to get a lesion checked as early as possible could hopefully avoid what could end up being a critical delay in the recognition of a melanoma,” he said.

Dr. Goldsmith also addressed lesion darkness. “The single criterion that seems to have the most impact on recognition of the smallest melanomas is the criterion of darkness,” he said.

The singular importance of darkness for the diagnosis of small-diameter melanomas has been described in several series (Tumori 2004;90:128-31; J. Eur. Acad. Dermatol. Venereol. 2007;21:929-34; Arch. Dermatol. 1998;134:103-4). These reports suggest that, “when evaluating a lesion of unknown history, an 8-mm lightly pigmented macule with symmetric variation in pigmentation—two of the four current ABCD features—is of less concern than a 3-mm, circular, evenly pigmented black macule or papule with none of the four current ABCD criteria,” Dr. Goldsmith said.

In other words, the criterion of darkness is a stand-alone, nonredundant feature to help recognize melanomas. “It just doesn't make sense that darkness is currently not even one of four objective criteria used in educational strategies related to melanoma recognition,” he said.

Dr. Goldsmith also provided evidence that increased emphasis on the criterion of darkness enhances other strategies to diagnose melanomas, including early recognition of asymmetry in melanomas (Arch. Dermatol. 1994;130:1013-7), recognition of change in melanomas, (Br. J. Dermatol. 1999;141:783-7), and identifying small “ugly ducklings” that are melanomas (Arch. Dermatol. 1998;134:103-4).

“Changing the D from diameter to dark would accomplish two goals: We would not deter the recognition of smaller melanomas, and we would educate patients and the public about how to recognize many smaller lesions of concern,” he said. This change would represent a true evolution of the ABCDE criteria, he added.

A related video is at www.youtube.com/InternalMedicineNews

Darkness is the criterion that 'seems to have the most impact on recognition of the smallest melanomas.'

Source Dr. Goldsmith

More biopsies of smaller lesions may avoid the possibility of “a critical delay in the recognition of a melanoma.”

Source Courtesy kimggraphics