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A simple aid for objective diagnosis of malignant melanoma

  • Author(s): Summers, DM
  • Azzawi, K
  • et al.
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A simple aid for objective diagnosis of malignant melanoma
DM Summers MA MB BChir, K Azzawi MD Msc CABS
Dermatology Online Journal 14 (7): 23

Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom. dmsummers@doctors.org.uk

Despite the recent stabilization of detection rates of Malignant Melanoma (MM) [1], the current UK incidence of over 8000 per year is a significant morbidity and mortality burden. The only effective treatment for Malignant Melanoma remains surgical excision so early detection is essential. Several systems have been developed to provide a reliable and reproducible analysis of pigmented skin lesions including the "Clinical ABCD criteria" [2], the "Dermatoscopic ABCD rule" [3] and the "7 point checklist" [4]. The UK melanoma guidelines [5] adopt the "7 point checklist" of which the major criteria include a change in lesion size and shape. Assessment of this usually relies on the history, a subjective and often unreliable measurement.

This letter presents a technique developed by a patient for demonstrating, objectively, an increase in the diameter and a change in shape of a pigmented skin lesion. The 22-year-old patient initially presented to her general practitioner, complaining of the growth of a mole on her abdomen. After examination, the primary care physician remained unconvinced of the reliability of the history of growth. The patient decided to document the change in the mole by applying scotch tape over it, describing the diameter with permanent marker, and keeping it in her diary. At 6 months she repeated the procedure and demonstrated a 2 mm increase in diameter. Subsequent biopsy revealed a malignant melanoma with 1.2 mm thickness that was removed with a wide local excision.

Despite the clarity of the guidelines, melanoma diagnosis remains an imprecise science. Experience alone appears not to be totally reliable and this technique provides a simple, objective aid for the general public.

References

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2. Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin. 1985 May-Jun;35(3):130-51. PubMed

3. Nachbar F, Stolz W, Merkle T, Cognetta AB, Vogt T, Landthaler M, Bilek P, Braun-Falco O, Plewig G. The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions. J Am Acad Dermatol. 1994 Apr;30(4):551-9. PubMed

4. MacKie RM, Doherty VR. Seven-point checklist for melanoma. Clin Exp Dermatol. 1991 Mar;16(2):151-3. PubMed

5. Bishop JA, Corrie PG, Evans J, Gore ME, Hall PN, Kirkham N, Roberts DL, Anstey AV, Barlow RJ, Cox NH; Melanoma Study Group; British Association of Dermatologists. UK guidelines for the management of cutaneous melanoma. Br J Plast Surg. 2002 Jan;55(1):46-54. PubMed

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