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Revisiting the ABCD Criteria

Naheed R. Abbasi, MPH, MD; Helen M. Shaw, PhD; Darrell S. Rigel, MD; Robert J. Friedman, MD; William H. McCarthy, FRACS; Iman Osman, MD; Alfred W. Kopf, MD; David Polsky, MD, PhD

JAMA. 2004;292:2771-2776.

Context  The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (6 mm) melanomas.

Evidence Acquisition  Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information.

Evidence Synthesis  Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color.

Conclusions  The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include "evolving"). No change to the existing diameter criterion is required at this time.

Author Affiliations: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY (Drs Abbasi, Rigel, Friedman, Osman, Kopf, and Polsky); and Sydney Melanoma Unit, Royal Prince Alfred Hospital, Sydney, Australia (Drs Shaw and McCarthy).

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