Malignant melanoma is the deadliest form of skin cancer. To readers of this blog, that shouldn’t come as any surprise. And for years, we’ve been taught the ABCDE rules on detecting melanoma. A stands for asymmetry; B is for borders so anything with ill-defined borders is suspect; C is for the color and whether the mole or lesion has more than one color; D stands for diameter and anything bigger than 6mm should get a look; and E was added a few years ago and represents an evolving lesion. All of these are very good checkmarks for most forms of malignant melanoma.
You knew there was going to be a “but”, right? My melanoma, amelanotic nodular melanoma, doesn’t like to play by those rules. In fact, the only letter than may come into play with this type of melanoma is D, and an amelanotic nodular melanoma lesion may burst onto the scene basically fully formed so you don’t even get the benefit of the E (my dermatologist – has this changed any? Me – nope, just popped out looking like that one day)…
So researchers at the Mayo Clinic in Arizona wanted to see if they switched up the rules whether people would get any better at detecting melanoma lesions. The screening follows what they call the “ugly duckling” rule. Basically what this means is that once you get a baseline of what your skin normally looks like, you notice any outliers. For example, I’ve got a lot of little brown moles on my arms and shoulders but virtually none on my legs. So for me, following the ugly duckling rule, I would notice anything that would be different from my baseline. So if a big pink thing popped up on my leg, I would go get that checked out since I don’t normally have anything on my legs. But if I got a couple more little brown spots on my arm, I wouldn’t.
The study found that those following the “ugly duckling” guidelines were accurate 90% of the time finding melanoma than those following the ABDCE group who were only 66.6% accurate.
The moral of the story is to learn what your skin is like normally, so you can then be able to identify anything that appears on your skin that doesn’t look like whatever your baseline is. Obviously more research needs to be done, but being able to recognize “that’s something unusual” early and get your butt into the doctor could save your life.