‘Do UC the melanoma?’ Recognising the importance of different lesions displaying unevenness or having a history of change for early melanoma detection

Abstract

We put forward for your consideration a new mnemonic: 'Do UC (different, uneven, changing) the melanoma?' This mnemonic encompasses differential, analytical and comparative cognition strategies for an enhanced early detection of melanoma.

Early detection of melanoma: Reviewing the ABCDEs

“…approach to emphasize the different, uneven, and changing characteristics of melanoma. 57 Another simple tool is the ''ugly duckling'' sign. Introduced by Grob and Bonerandi 58 in 1998, it is based on the premise that an individual's nevi share common characteristics (ie, a ''signature nevus'' 59 ), and that melanoma often deviates from this nevus pattern.…”

A unifying approach to the clinical diagnosis of melanoma including “D” for “Dark” in the ABCDE criteria

“…Most approaches to melanoma diagnosis have included some predominant emphasis or combination of emphases on recognition of changing lesions, recognition of outlier (“ugly-duckling”) lesions, and specific melanoma characteristics, with the most utilized criteria being the ABCDE criteria (“A” for “Asymmetry,” “B” for “Border irregularity,” “C for Color variation,” “D for 6 mm Diameter,” and “E” for “evolving lesions”) [8]. Many recently published strategies have rejected the diameter criterion as well as abandoned all or portions of the ABCDE mnemonic [3,5,9–12]. Many of these proposed strategies, including the “D” for “Dark” proposal I offered, have also added emphasis on recognition of darkness as a particular feature of concern in pigmented lesions [5,10–12].…”

Melanoma recognition using extended set of descriptors and classifiers

“…However, the number of yearly deaths from melanoma continues to increase, and the overall melanoma mortality rate is one of the few cancer mortality rates not on the decline [1][2][3]. These realities combined with increasing evidence of the lack of efficacy of the clinically assessed ABCDE criteria ("A" for "asymmetry," "B" for "border irregularity," "C" for "color variation," "D" for "diameter," and "E" for "evolving lesions") have necessitated ongoing efforts to enhance the earlier clinical detection of melanoma [3,4].…”

“…These realities combined with increasing evidence of the lack of efficacy of the clinically assessed ABCDE criteria ("A" for "asymmetry," "B" for "border irregularity," "C" for "color variation," "D" for "diameter," and "E" for "evolving lesions") have necessitated ongoing efforts to enhance the earlier clinical detection of melanoma [3,4].…”

“…Some recently published strategies have rejected the diameter criterion as well as abandoned all or portions of the ABCDE mnemonics [3][4][5]. The additional problems with application of the ABCDE descriptors appear for extensive lesions, for which the borders of lesions are outside the dermoscopic image or there is a smooth transition between the lesions and the healthy skin.…”